Surgical Management of Biopolymer Induced Granulomatous Hypercalcemia and Renal Insufficiency: A Case Report and Literature Review.

Abstract

Volumetric enhancement is a key component of body contouring, with injections of natural or synthetic biopolymers being one of the most common methods used. Biopolymers, however, are associated with both acute and chronic complications including the risk of granulomatosis and hypercalcemia. Unrecognized and untreated, biopolymer-induced granulomatous hypercalcemia can lead to renal failure, metastatic calcifications, and death. Medical management is the primary treatment for biopolymer-induced granulomatous hypercalcemia, with corticosteroids and other drugs targeting calcium metabolism and immunomodulation. In cases refractory to medical management, surgical excision of biopolymer granulomatous tissue can normalize serum calcium and improve renal function. This case report of 2 patients and literature review of 4 patients investigates the rare surgical management of patients with biopolymer-induced granulomatous hypercalcemia, the morbidity of such a procedure, and adjunctive techniques that may be utilized to facilitate biopolymer removal and reduce complications.