A Case of Thrombotic Microangiopathy and Acute Sarcoidosis

Abstract

Although sarcoidosis is an established cause of multiorgan dysfunction, acute presentation with thrombotic microangiopathy resulting in severe renal and hematological sequelae has not been reported. We describe the case of a patient presenting with hypercalcemia, pancreatitis, and acute renal failure, followed by microangiopathic hemolytic anemia. Although there were no significant respiratory symptoms, thoracic radiology and mediastinal lymph node biopsy results were in keeping with sarcoidosis as the underlying cause of this multisystem presentation. Corticosteroids were commenced with clinical and biochemical improvement. This novel case highlights the need to consider sarcoidosis as part of the differential diagnosis for unusual multiorgan presentations and for early multidisciplinary involvement in such cases to permit optimal treatment.

Keywords: Hemolytic anemia; ILD; MAHA; TMA; sarcoidosis; thrombotic microangiopathy.

Figure 1

Chest radiograph on presentation to hospital without respiratory symptoms.

Figure 2

Blood film showing microangiopathic hemolytic anemia, with arrows noting schistocytes.

Figure 3

Cross-sectional imaging. A, CT scan of thorax (lung window) showing lung parenchymal changes. B, C, Non-contrast–enhanced CT scan of thorax (mediastinal soft tissue window) showing multiple enlarged (up to 2.8 cm) noncalcified thoracic lymph nodes involving stations 4R (red arrow), 4L (yellow arrow), and 7 (blue arrow).

Figure 4

Histopathology results confirming diagnoses. A, Renal biopsy showing glomerular acute thrombotic microangiopathy with mesangiolysis: red arrow indicating capillary lumen occluded by endothelial cell swelling and the blue arrow indicating acute inflammatory cells in capillary lumen. B, Endobronchial ultrasound-guided transbronchial fine needle aspiration section showing a non-necrotizing granuloma.