An unusual complication of injecting paraffin oil to enhance body sculpting
June 20, 2014, 9:25 am
Severe hypercalcaemia, nephrocalcinosis, and multiple paraffinomas caused by paraffin oil injections in a young bodybuilder. Gyldenløve M et al. Lancet 2014 Jun14;383:2098
This short case report describes a 23-year-old male bodybuilder who presented with scrotal pain. The patient also admitted to shortness of breath and chest tightness. Workup for infection and nephrolithiasis was negative. Laboratory tests revealed anemia, renal insufficiency, and severe hypercalcemia (free calcium approximately twice normal.) Physical examination revealed multiple dense nodules in the skin and subcutaneous tissue over the upper torso and biceps. There was no evidence of sarcoidosis.
The patient had been injecting paraffin oil as an adjunct to body sculpting. Biopsy showed that the nodules were paraffinomas with inflammatory foreign-body response. Pulmonary evaluation revealed segmental perfusion defects, diffuse infiltration, and lipoid pneumonia. Kidney biopsy showed nephrocalcinosis.
The authors point out that common causes of hypercalcemia include hyperparathyroidism, malignancy, and sarcoidosis. Unusual causes include granulomatous foreign-body reactions. Normally, calcium levels are regulated by parathyroid hormones and calcitriol, an active metabolite of vitamin D that is formed in the kidneys:
Vitamin D ——————> 1,25 hydroxyvitamin D (calcitriol)
This reaction is catalyzed by the enzyme CYP27B1. This enzyme is also released by macrophages and other inflammatory cells in a process not regulated by pathways that normally control calcium levels.
The patient in this case improved after treatment with fluids, steroids and pamidronate.
Here is a review of calcium and phosphate metabolism from Dr. Eric Strong of Stanford:
And here is Dr. Strong’s YouTube lecture on hypercalcemia: