Case reports of hypercalcemia and chronic renal disease due to cosmetic injections of polymethylmethacrylate (PMMA) / Relatos de casos de hipercalcemia e doença renal crônica devidas a injeções de polimetilmetacrilato (PMMA) por razões estéticas

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.

Resumo Injeções de preenchimento de caráter estético são procedimentos comuns em cirurgia plástica em todo o mundo. O polimetilmetacrilato (PMMA) é um material de preenchimento aprovado apenas para procedimentos minimamente invasivos no tecido facial, e está entre as substâncias injetáveis mais frequentemente usadas para fins estéticos. A injeção de um grande volume de PMMA pode levar ao desenvolvimento de hipercalcemia grave e lesão renal crônica em uma frequência provavelmente subestimada. Nesses casos, a hipercalcemia se desenvolve devido a uma reação granulomatosa de corpo estranho, secundária à produção extrarenal de calcitriol. No presente artigo, descrevemos os casos de dois pacientes que receberam injeções de grandes volumes de PMMA e desenvolveram hipercalcemia grave e doença renal crônica avançada. Esses relatos destacam a importância de seguir as regulamentações sobre o uso do PMMA e informar adequadamente os pacientes sobre a possibilidade de complicações antes de realizar tais procedimentos.

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

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.

Púrpura trombocitopênica trombótica decorrente de infecção urinária complicada / Thrombotic thrombocytopenic purpura due to a complicated urinary tract infection

Os autores relatam um caso infreqüente de púrpura trombocitopênica trombótica associada à infecção urinária por Escherichia coli e apresentam uma revisão bibliográfica sobre o assunto. A púrpura trombocitopênica trombótica é uma complicação incomum da infecção urinária por Escherichia coli. Caracteriza-se por anemia hemolítica microangiopática, trombocitopenia, sintomas neurológicos, insuficiência renal e febre. Entretanto, somente 40% dos casos apresentam todos esses sinais/sintomas. Sua evolução pode ser fatal se não for diagnosticada e tratada precocemente. No caso descrito, somente o tratamento agressivo do quadro séptico, com antibióticos, medidas de suporte e remoção do foco infeccioso (nefrectomia), e o manejo da púrpura trombocitopênica, com imunoglobulina, corticoterapia e plasmaférese associada à reposição de plasma fresco possibilitaram a recuperação da paciente (AU)

The authors report a rare case of a patient with thrombotic thrombocytopenic purpura associated with Escherichia coli urinary tract infection and present a review about this subject. Thrombotic thrombocytopenic purpura is an uncommon complication of Escherichia coli urinary tract infection. It is characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, renal failure and fever. However, only 40% of cases do present all of these signs and symptoms. The disease can be fatal if not diagnosed and treated early. In our report, only the aggressive management of the urinary sepsis, with general measures, antibiotics and the removal of the septic focus (with nephrectomy), and the treatment of the thrombotic thrombocytopenic purpura with immunoglobulins, corticosteroids and plasmapheresis with administration of fresh plasma have allowed the patient to recover (AU)