Hypercalcemia associated with foreign body granuloma in a patient with HIV

Abstract

Granulomatous diseases, such as sarcoidosis, tuberculosis, have been associated with parathyroid-independent hypercalcemia. The unifying mechanism is attributed to elevated extrarenal 25-hydroxyvitamin D 1α hydroxylase (1α-hydroxylase) activity in tissue macrophages, leading to increased serum 1,25-dihydroxyvitamin D level. Foreign material introduced into human body may elicit a granulomatous reaction with hypercalcemia. We report a 38-year-old HIV-infected woman who initially presented with severe hypercalcemia. She was under antiretroviral treatment with no opportunistic infections. Initial search for a malignant or infectious process yielded no diagnosis, but elevated 1,25-dihydroxyvitamin D level, in the setting of suppressed PTH, suggested the presence of excessive 1α-hydroxylase activity. PET- TC localized hypermetabolic lesions in both buttocks and finally biopsy confirmed granulomatous foreign reaction due to injections of polymethylmethacrylate.