SUN-796 Hypercalcemia Associated with Cosmetic Oil Injection

Abstract Disclosure: A. Sainz-Mejias: None. J.E. Esquivel Vargas: None. L. Ulate Oviedo: None. Background: Hypercalcemia is observed in 0.2-4% of the population, with varying incidence depending on the etiology. The PTH-independent cases associated with peripheral activation of 1,25-dihydroxivytamin D should always be considered. Since the 1950s, there has been a global trend toward increasing cosmetic use of inorganic oils, however, hypercalcemia related to cosmetic oil injection is an underreported complication associated with high rates of acute and chronic kidney injury, and even death. Clinical case: A 49-year-old female underwent a cosmetic procedure involving mineral oil injections in both gluteal regions 14 years ago. A year later, she was misdiagnosed with systemic lupus erythematosus and lupus nephritis, treated with immunosuppressive drugs. For the past four years, she had severe hypercalcemia and calcinosis cutis which led to chronic ulcers. She presented with hypercalcemia and hyperphosphatemia (calcium 13.1mg/dL, phosphorus 5.57mg/dL), acute renal injury (creatinine 2.34mg/dL), and low 25-OHD3 levels (24.5ng/mL) with suppressed PTH (1pg/mL), with low PTHrP (0.8pmol/L) and high 1,25-OHD3 levels (120pg/mL). Ultrasound imaging showed nephrocalcinosis and calcifications in soft tissues and arteries. Biopsy of the ulcers showed extensive ulceration and granulation tissue, with fragments of dense fibrous connective tissue containing extensive deposits of inorganic, basophilic granular material with areas of dense calcification, findings consistent with the migration of inorganic substances to the dermis, causing secondary ischemia. The patient was diagnosed with hypercalcemia and calcinosis associated with cosmetic oil migration, received intravenous antibiotics, zoledronic acid and oral prednisone, and then was discharged on ketoconazole and prednisone, achieving continued improvement in her clinical and renal condition. Conclusion: This case report presents a rare instance of hypercalcemia associated with cosmetic oil injection, with peripheral production of 1,25-dihydroxivytamin D, without granuloma formation, likely due to initial pharmacological immunosuppression. It urges us to consider the importance of recognizing potential complications of such cosmetic procedures and promptly addressing them with targeted therapy. Presentation: Sunday, July 13, 2025