INTERESTING IMAGE 67 Ga Uptake After Cosmetic Augmentation With Silicone in HIV- Infected Patient With Unexplained Hypercalcemia Utility of SPECT/CT Aron Gould-Simon, MD,*† William Erdman, MD,*† and Orhan K. O ¨ z, MD, PhD*† Abstract: A 56-year-old HIV-infected man underwent 67 Ga scintigraphy because of unexplained hypercalcemia, elevated calcitriol, and concern for chronic granulomatous disease, including tuberculosis. Although no abnor- malities were identified to indicate sarcoidosis or tuberculosis, increased radiotracer accumulation in the face and gluteal region was observed. On questioning, the patient revealed a 3-year history of liquid silicone use for soft-tissue augmentation of the face and buttocks. After SPECT/CT imaging, the etiology of the patient’s hypercalcemia was attributable to silicone- induced granulomatosis. We present this case to highlight the appearance of 67 Ga uptake on SPECT/CT after cosmetic augmentation with liquid silicone in the face and buttocks and silicone-induced granulomatosis as a cause of unexplained elevated vitamin D and hypercalcemia. Key Words: gallium, granulomatosis, hypercalcemia silicone, SPECT/CT (Clin Nucl Med 2012;37: 298 –300) REFERENCES 1. Leman J, Gray RW. Calcitriol, calcium, and granulomatous disease. N Engl J Med. 1984;311:1115–1116. 2. Lopiccolo MC, Workman BJ, Chaffins ML, et al. Silicone granulomas after soft-tissue augmentation of the buttocks: a case report and review of manage- ment. Dermatol Surg. 2011;37:720 –725. 3. Wosnitzer B, Mirtcheva R. Silicone granulomas following free silicone gluteal augmentation. Radiol Case Rep. 2010;6:491. 4. Ho L, Wassef H, Seto J. FDG PET/CT imaging in granulomatous changes secondary to breast silicone injection. Clin Radiol. 2010;65:659 – 661. 5. Schwartzfarb EM, Hametti JM, Romanelli P. Foreign body granuloma forma- tion secondary to silicone injection. Dermatol Online J. 2008;14:20. 6. Decorato D, Derogatis AJ. Prominent gallium uptake associated with silicone implants in an asymptomatic patient. Clin Nucl Med. 1994;19:1107–1108. 7. Chen CJ, Lee BF, Yao WJ, et al. A false positive 18 F-FDG PET/CT scan caused by breast silicone injection. Korean J Radiol. 2009;10:194 –196. 8. Palestro CJ, Chau P, Goldsmith SJ. Gallium-67 uptake after breast and hip augmentation with silicone. Clin Nucl Med. 1992;17:897– 898. 9. Kozeny GA, Barbato AL, Bansal VK, et al. Hypercalcemia associated with silicone-induced granulomatosis. N Engl J Med. 1984;311:1103–1105. Received for publication August 2, 2011; revision accepted November 29, 2011. From the *Department of Radiology, Division of Nuclear Medicine, UT South- western Medical Center, Dallas, TX; and †Department of Radiology, Division of Nuclear Medicine, Parkland Hospital, Dallas, TX. Conflicts of interest and sources of funding: none declared. Reprints: Orhan K. O ¨ z, MD, PhD, Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 – 9058. E-mail: Orhan.Oz@UTSouthwestern.edu. Copyright © 2012 by Lippincott Williams & Wilkins ISSN: 0363-9762/12/3703-0298 Clinical Nuclear Medicine • Volume 37, Number 3, March 2012 298 | www.nuclearmed.com