首例报告硅胶注射诱发肉芽肿形成高钙
今天和大家分享的病例较为罕见，患者硅胶注射美容后出现肉芽肿病和高钙血症，并最终导致肾结石，结合患者手术史、成像检查、实验室评估和组织病理学检查等明确诊断了患者的基础病因，并对潜在机制进行了描述，患者最终获得了成功治疗，希望对您有所启发。
Siliconeinjection-inducedgranulomaformation,hypercalcemiaandnephrolithiasis:acasereport
硅胶注射诱发肉芽肿形成、高钙血症和肾结石：病例报告
Abstract摘要Hypercalcemiaandnephrolithiasishavebeenassociatedwithvariousetiologies,includingdysregulationoftheparathyroidglands,malignancies,orsarcoidosis.Othercausesofhypercalcemia,suchasgranulomatousdiseaseresultingfromsilicone-basedcosmeticinjections,havebeenreportedbutwithoutspecificemphasisonnephrolithiasis.Herein,wereportanunusualcaseofsimultaneousbilateralobstructingureteralcalculi(SBUC)triggeredbyrecalcitranthypercalcemiaandgranulomatousdiseaseduetosilicone-basedcosmeticinjections.Acarefulsurgicalhistory,physicalexam,andimagingidentifiedtheunderlyingetiology,whichwasconfirmedbyfinalhistopathology.Usingamultidisciplinaryapproach,thepatientsconditionwassuccessfullymanagedwithendoscopicproceduresandconcurrentcorticosteroidtherapy.
高钙血症和肾结石有多种病因，包括甲状旁腺失调、恶性肿瘤或结节病。高钙血症的其他诱因，如硅胶注射美容导致的肉芽肿病，也有报道，但没有特别强调该诱因与肾结石的相关性。本文报告了一例罕见病例，因硅胶注射美容出现顽固性高钙血症和肉芽肿病，随后导致双侧输尿管梗阻性结石（SBUC）。对手术史、体格检查和成像检查结果进行仔细分析确定了基础病因，并通过最终组织病理学检查证实。采用多学科的方法，通过内镜手术联合皮质类固醇治疗对患者进行了成功治疗。
Introduction介绍Severalcasereportshavedescribedthedevelopmentofnoncaseatinggranulomasandresultanthypercalcemiafollowingcosmeticsiliconeinjection.Whileitsmechanismremainspoorlyunderstood,T-cellmediatedactivationcantriggerformationandactivationofgranulomas,resultinginhypercalcemia.Oftentimes,gastrointestinalcalciumabsorptionalsooutpacesparathyroidhormone(PTH)suppression,therebyleadingtohypercalcemia-awell-documentedabnormalityamonggranulomatousdiseasesregardlessofetiology.Herein,wereportacaseofsimultaneousobstructingbilateralureteralcalculi(SBUC)resultingfromhypercalcemiaandsilicone-associatedgranulomatousdisease.Furthermore,wedescribeacaseofrapidureteralstentencrustationinthissetting.
目前已有多个病例报告描述了患者在硅胶注射美容后出现非干酪样肉芽肿并导致高钙血症。虽然尚不清楚相关的机制，但T细胞介导的免疫反应可触发肉芽肿的形成，并导致高钙血症。胃肠对钙的吸收速度过高，且甲状旁腺激素（PTH）分泌的抑制速度较低，因此引起高钙血症，这是肉芽肿性疾病中一种常见的现象，无论病因如何。本文报告的病例，患者出现高钙血症和硅胶相关肉芽肿性疾病，并最终导致双侧输尿管梗阻性结石（SBUC）。此外，我们还对该病例输尿管支架快速结壳的情况进行了描述。
Casereport病例报告A35-year-oldhealthy,CaucasianfemalepresentedtotheEmergencyDepartment(ED)withsubjectivefevers,flankpain,andnausea.Herpastsurgicalhistorywasnotableforbreastandglutealaugmentation,thelatterviaautologousfatandsiliconeinjections.Oninitialpresentation,shewasafebrileandhemodynamicallystable.Thephysicalexamrevealedmildleftcostovertebralangletendernessandsuprapubictenderness.Laboratorytestsrevealedanormalserumcreatinineof0.98mg/dL,mildleukocytosisto10.9xμL,andhypercalcemiawithaserumcalciumof11.6mg/dL.
患者，女性，35岁，高加索人，因主观发热、腰痛和恶心到急诊科（ED）就诊。患者具有隆乳和隆臀手术史，其中隆臀术是通过自体脂肪和硅胶注射进行的。初次就诊时，患者无发热且血流动力学稳定。体格检查显示存在左肋脊角轻度压痛和耻骨上压痛。实验室检查显示血清肌酐浓度为0.98mg/dL，处于正常范围内；轻度白细胞增多，为10.9xμL；高钙血症，血清钙为11.6mg/dL。
Urinalysiswithmicroscopywasnitritenegativebutdemonstratedpyuria(25WBCperhighpowerfield).Non-contrast
