Case reports of hypercalcemia and chronic renal disease due to cosmetic injections of polymethylmethacrylate (PMMA)

Abstract Cosmetic injections of fillers are common plastic surgery procedures worldwide. Polymethylmethacrylate (PMMA) is a filler approved only for minimally invasive procedures in facial tissue and is among the most frequently used injectable substances for cosmetic purposes. Injection of a large volume of PMMA may lead to the development of severe hypercalcemia and chronic kidney damage in a probably underestimated frequency. In such cases, hypercalcemia develops due to a granulomatous foreign body reaction with extrarenal production of calcitriol. In the present report, we describe the cases of two patients who received injections of large volumes of PMMA and developed severe hypercalcemia and advanced chronic kidney disease. These reports highlight the importance of adhering to regulations regarding the use of PMMA and properly informing patients of the possibility of complications before undertaking such procedures.摘要 美容填充注射是全球范围内常见的整形外科手术。聚甲基丙烯酸甲酯（Polymethylmethacrylate，PMMA）是仅获批用于面部组织微创操作的填充剂，亦是美容临床最常用的注射用物质之一。大剂量注射PMMA可能引发严重高钙血症与慢性肾损伤，且该不良反应的发生频率或被低估。此类病例中，高钙血症的发生源于肉芽肿性异物反应伴肾外骨化三醇生成。本报告描述了2例接受大剂量PMMA注射后，出现严重高钙血症与晚期慢性肾病的患者病例。本系列病例报告强调，需严格遵守PMMA使用相关监管规范，并在实施此类手术前充分告知患者可能出现的并发症风险。