Severe hypercalcemia related to silicone granulomas, as discovered by FDG-PET

Abstract

Silicone injected for cosmetic purposes can provoke an inflammatory granulomatous response. In turn, silicone granulomas can lead to hypercalcemia, which is a rare, though potentially life-threatening condition. Hypercalcemia is a nonspecific laboratory finding with many potential etiologies. It may be difficult for clinicians to diagnose silicone-induced hypercalcemia, since the history of cosmetic silicone injections may not be elicited from the patient. Positron emission tomography using F-18-fluorodeoxyglucose (FDG-PET) can be used to evaluate patients with unexplained hypercalcemia as a means of searching for an occult malignancy or granulomatous process. FDG-PET findings may be the initial and perhaps only indication of silicone granulomas as the cause of hypercalcemia. Nuclear medicine physicians should have a low threshold for suggesting this diagnosis, particularly in the setting of unexplained hypercalcemia. This case report highlights the value of FDG-PET in diagnosing silicone granuloma-induced hypercalcemia.