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Case Report

An Atypical Case of Extrapulmonary Sarcoidosis with Severe Hypercalcemia as Initial Presentation, Successfully Treated with Glucocorticoids

1
Department of Medicine, University of Missouri, Columbia, MO 65212, USA
2
School of Medicine, University of Missouri, Columbia, MO 65212, USA
3
Department of Rheumatology, University of Missouri, Columbia, MO 65212, USA
4
Department of Pathology, University of Missouri, Columbia, MO 65212, USA
*
Author to whom correspondence should be addressed.
Clin. Pract. 2024, 14(4), 1264-1269; https://doi.org/10.3390/clinpract14040102
Submission received: 19 March 2024 / Revised: 5 May 2024 / Accepted: 21 June 2024 / Published: 29 June 2024

Abstract

Background: Sarcoidosis is a multisystemic disease that is histologically characterized by non-caseating granulomas in one or more organs. Although hypercalcemia is commonly seen in sarcoidosis, clinically significant hypercalcemia as the initial presentation of sarcoidosis is exceedingly rare. Long-standing hypercalcemia can lead to several complications and needs to be adequately managed to prevent irreversible damage. Currently, there are no standard treatment guidelines for sarcoidosis-induced hypercalcemia, although glucocorticoids have often been used as first-line therapy. Case Report: We describe a 55-year-old male patient who presented with dull right upper quadrant abdominal pain and a 30-pound weight loss over one month. He was found to have severe hypercalcemia, which was treated with intravenous (IV) normal saline and intramuscular calcitonin. Imaging studies revealed hypodense lesions throughout the bilateral hepatic lobes, spleen, and bilateral kidneys, with no pathologic mediastinal, hilar, supraclavicular, or axillary lymphadenopathy or pulmonary parenchymal disease. A splenic biopsy confirmed extrapulmonary sarcoidosis. After initial discharge, the patient was re-admitted weeks later for severe hypercalcemia, which was successfully treated with the initiation of prednisone. Conclusions: In this report, we present an atypical case of isolated extrapulmonary sarcoidosis with severe hypercalcemia as the initial presentation, successfully treated with steroids.
Keywords: sarcoidosis; hypercalcemia; glucocorticoids sarcoidosis; hypercalcemia; glucocorticoids

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MDPI and ACS Style

Mittal, S.; Pogorzelski, K.; Huxel, C.; Siva, C.; Rao, D. An Atypical Case of Extrapulmonary Sarcoidosis with Severe Hypercalcemia as Initial Presentation, Successfully Treated with Glucocorticoids. Clin. Pract. 2024, 14, 1264-1269. https://doi.org/10.3390/clinpract14040102

AMA Style

Mittal S, Pogorzelski K, Huxel C, Siva C, Rao D. An Atypical Case of Extrapulmonary Sarcoidosis with Severe Hypercalcemia as Initial Presentation, Successfully Treated with Glucocorticoids. Clinics and Practice. 2024; 14(4):1264-1269. https://doi.org/10.3390/clinpract14040102

Chicago/Turabian Style

Mittal, Sushmita, Karolina Pogorzelski, Christopher Huxel, Chokkalingam Siva, and Deepthi Rao. 2024. "An Atypical Case of Extrapulmonary Sarcoidosis with Severe Hypercalcemia as Initial Presentation, Successfully Treated with Glucocorticoids" Clinics and Practice 14, no. 4: 1264-1269. https://doi.org/10.3390/clinpract14040102

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