Hypercalcemia in sarcoidosis disease

Introduction: Sarcoidosis is a systemic multi-organ disease with formation of granuloma. Several studies have advocated that the innate immune failure in responding topersistent antigens causes Granuloma formation of sarcoidosis. Hypercalcemia, hypercalciuria and osteoarticular manifestations are known concerning features ofsarcoidosis in 5 to 11% of cases. In addition, hyperparathyroidism in sarcoidosis patients can cause hypercalcemia. High level of Calcium in 24-hour urinespecifies the existence of active sarcoidosis disease in the patient. Herein, we report a case of hypercalcemia with renal failure and sarcoidosis. Case Report: In March 2017, a 50-year-old man with drowsiness, weakness and confusions attended to Masih Daneshvari Hospital. His serum calcium and creatinine levels were 15.2 mg/ dL and 3.2 mg/dL, respectively. However, ultrasound examination of kidney did not reveal any kidney stones. Kidney biopsy showed fibrosis with no significant changes in pathological evaluation. Although the patient received noncalcium dialysis fluid for six months, no improvements in skin lesions and total health of patient were observed. Subsequently he underwent the diagnostic biopsy of lymph node and skin. Both specimens were composed of numerous granulomas with epithelioid histocytes and multinucleated giant cells without central caseating necrosis, characteristic for sarcoidosis. With the onset of treatment with corticosteroid, the serum creatinine level decreased to 2.1 mg/dl ofnormal value and the patient showed significant health improvements.

Keywords:

Hypercalciema , Hypercalciuria , Sarcoidosis , Vitamin D.