Diagnostic dilemma: A man’s muscles looked strangely deformed. Doctors found they were leaking calcium into his blood.
The patient: A 60-year-old man in Warsaw, Poland
The symptoms: The man went to the hospital after vomiting for two days. Additionally, over the previous year, he had developed weakness and lost 40 pounds (18 kilograms) without trying.
Doctors treated the patient with a diuretic to help remove excess calcium, as well as intravenous fluids, a steroid and a calcium-reducing medication. His calcium levels briefly dropped and he was released with a few prescriptions. However, three weeks later, during a follow-up, doctors found that his blood calcium level had increased again and he was admitted to a nephrology ward.
The man was generally stable, but a physical exam showed notable changes in the muscles of his upper arm and chest, matching irregularities seen on scans. Doctors then re-examined the patient’s medical history and he shared a crucial detail: About 30 years earlier, he had begun receiving “unknown intramuscular injections (probably containing testosterone)” into the muscles of his chest and upper arm to enlarge them, according to a report. report of his case.
“He emphasized that the last dose of these injections was received 2 years ago,” note the authors of the report. Exactly how often he had received the injections is unclear.
Blood tests have shown that the human calcium control system parathyroid hormone was significantly low, ruling out a common hormonal cause of high calcium. The man also had no signs of hidden cancer in his digestive tract, no abnormalities on a urological evaluation, and no signs of autoimmune disease. Excluding other causes, the medical team biopsied one of the abnormal muscle areas.
The diagnosis: Microscopically, the muscle was filled with an oil-based, silicone-like substance and surrounded by dense deposits of calcium. The team deduced that the man’s previous muscle injections likely contained synthola substance composed primarily of oil that visually “plumps” muscles, essentially inflating them like water balloons.
In this case, the synthol had triggered a persistent foreign body reaction – the body essentially reacting to a material it couldn’t break down. Over time, this reaction produced scarring and calcification, storing large amounts of calcium inside the muscle. And eventually, that calcium ended up in his blood.
The treatment: A couple previous reports Similar cases suggest that surgical removal of calcified muscle would be the only reliable long-term treatment for this man’s persistently elevated calcium. In a previous patient, calcium levels have returned to normal three months after tissue removal. However, in this man’s case, the authors did not specify whether the patient ultimately underwent surgery, nor did they describe his long-term course.
What makes the case unique: Synthhol injections typically contain 85% medium-chain triglycerides, 7.5% of a local anesthetic like lidocaine, and 7.5% alcohol, allegedly for infertility. The oils act as a muscle-building agent because the body does not process them easily and the effects of these injections can linger for years. Although it carries serious risks, such as muscle deformities, chronic wounds and scars, synthol is relatively easy to buy.
Only two other cases of hypercalcemia linked to synthol injections have been reported, the report’s authors note, and both were from Lebanon. The underlying mechanism causing this effect remains unclear. Synthol’s best-known complications usually appear shortly after an injection, but in this patient the effects apparently appeared years later, making the cause unusually difficult to identify.
According to the authors, this case adds further evidence that “intramuscular injections of synthhol are among the causes of elevated serum calcium levels,” despite its rarity.
For more intriguing medical cases, check out our Diagnostic Dilemma Archives.
This article is for informational purposes only and is not intended to offer medical advice.
