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Abstract: SA-PO318

The Pursuit of the Perfect Body: Need for Myocardial Revascularization and Dialysis After Polymethylmethacrylate Injection

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Freire Filho, Washington Alves, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Gonçalves, José Guilherme Rezende Ramos Salles, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Maia, Tassila Gomes, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Kassar, Liliana M L, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Lima, Carolina Marquez, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Araujo, Maria Julia C. L. N., Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Via Reque Cortes, Daniela del Pilar, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Guimarães, André Pessoa Bonfim, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Medeiros, Renato Lourenço de, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Vivanco Balcazar, Lizbeth Karolina, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
  • Moyses, Rosa M.A., Universidade de Sao Paulo Hospital das Clinicas, São Paulo, São Paulo, Brazil
Introduction

Polymethylmethacrylate (PMMA) is a synthetic polymer, initially used to correct HIV-associated lipodystrophy. However, gluteal augmentation for aesthetic purposes are procedures that are increasingly performed all over the world, mainly in Latin America. PMMA can promote foreign body granulomas around its microspheres, leading to increased calcitriol synthesis and, consequently, hypercalcemia.

Case Description

A 58-year-old female patient with a history of arterial hypertension, type-2 diabetes mellitus and sleeve gastrectomy performed a gluteal bioplasty with PMMA 2 years ago. Thirty days after the procedure, the patient had type A anginal pain, acute myocardial infarction with ST-segment elevation and the need for myocardial revascularization. Upon admission, there was evidence of increased serum creatinine, associated with parathyroid-independent hypercalcemia and hyperphosphatemia. In the following 4 months, the patient progressed to end-stage chronic kidney disease and required renal replacement therapy. Renal biopsy showed 60% of tubular atrophy and interstitial fibrosis, with intratubular calcific casts. Positron emission tomography showed irregular densifications in the gluteal muscular plane (fig 1). Despite the previously described findings, no specific treatment was prescribed, as the proper diagnosis of hypercalcemia etiology was not done.

Discussion

PMMA injection promotes granulomatous reaction, with overexpression of 1α-hydroxylase. This leads to extrarenal production of calcitriol by macrophages, and subsequent hypercalcemia, associated with vascular calcification and nephrocalcinosis. This environment favors the onset of acute kidney injury and the progression of vascular damage. If not identified and treated quickly, it may predispose to ischemic events and progression to chronic kidney disease. As some patients have an unfavorable evolution even after treatment, the use of PMMA in large quantities should be prohibited.

Fig 1