Severe Hypercalcemia Secondary to Paraffin Oil Injections In A Bodybuilder With Significant Findings on Scintigraphy

Parul Khanna, MD; Alireza Khatami, MD; Mina Swiha, MD; Irina Rachinsky, MD; Zahra Kassam, MD; Amanda J. Berberich, MD

AACE Clinical Case Reports (Sep 2020)

Severe Hypercalcemia Secondary to Paraffin Oil Injections In A Bodybuilder With Significant Findings on Scintigraphy

Parul Khanna, MD,
Alireza Khatami, MD,
Mina Swiha, MD,
Irina Rachinsky, MD,
Zahra Kassam, MD,
Amanda J. Berberich, MD

Affiliations

Parul Khanna, MD: From the Department of Medicine, London, Ontario.
Alireza Khatami, MD: the Department of Medical Imaging, Division of Nuclear Medicine Schulich School of Medicine and Dentistry, London, Ontario.
Mina Swiha, MD: the Department of Medical Imaging, Division of Nuclear Medicine Schulich School of Medicine and Dentistry, London, Ontario.
Irina Rachinsky, MD: the Department of Medical Imaging, Division of Nuclear Medicine Schulich School of Medicine and Dentistry, London, Ontario.
Zahra Kassam, MD: the Department of Medical Imaging, Division of Radiology Schulich School of Medicine and Dentistry, Western University, London, Ontario.
Amanda J. Berberich, MD: Address correspondence to Dr. Amanda Berberich, Department of Medicine, Saint Joseph’s Health Care London, 268 Grosvenor Street, London, ON, Canada, N6A 4V2.; From the Department of Medicine, London, Ontario.

Journal volume & issue: Vol. 6, no. 5
pp. e234 – e238

Abstract

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ABSTRACT: Objective: Non-parathyroid hormone (PTH) mediated hypercalcemia in young patients is rare. It encompasses a broad differential including malignancy, granulomatous diseases, Addison disease, and toxicity of vitamin A and D. We present an unusual case of non-PTH mediated hyper-calcemia in a previously healthy bodybuilder, secondary to multifocal granulomatous disease from paraffin oil injections. Methods: The patient was evaluated with laboratory tests including serum calcium, 25-hydroxyvitamin D, 1,25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone-related peptide. Imaging studies such as thorax computed tomography and bone scans were also performed. Results: A 31-year-old male bodybuilder presented with severe hypercalcemia (corrected calcium 3.1 mmol/L) and renal failure (creatinine 840 μmol/L), with suppressed PTH 1.0 pmol/L (normal, 1.6 to 6.9 pmol/L), and 1,25-vitamin D 205 pmol/L (normal, 60 to 208 pmol/L). He had used anabolic steroids for bodybuilding purposes for 8 years, with the possibility that he may also have used paraffin oil injections. Computed tomography imaging along with patient history suggested multiple paraffinomas in the pectoralis muscles causing granulomatous foreign body reaction as a potential cause for his hypercalcemia. He was prescribed a trial of prednisone, but he discontinued it due to symptoms of acne. Unfortunately, due to poor adherence with medical direction, management of his hypercalcemia remains challenging with inconsistent use of steroids and pamidronate infusions. Conclusion: Granulomatous foreign-body reactions are a rare side effect of paraffin oil injections used for muscle augmentation. These can lead to serious long-term side effects of severe hypercalcemia and renal failure, as seen in our patient. Prognosis is generally poor, with long term steroids as the preferred treatment. Abbreviations: CT computed tomography CYP24A1 24-hydroxylase ED Emergency Department PTH parathyroid hormone

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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