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Case Reports
. 2024 Aug 21;16(8):e67406.
doi: 10.7759/cureus.67406. eCollection 2024 Aug.

An Atypical Presentation of Sarcoidosis

Chelsea J Kubinec  1 , Zaeem A Siddiqi  1 , Lauren Bolster  1 , Christopher Fung  2 , Aldo J Montano-Loza  1 , Safwat Girgis  3 , Jennifer Ringrose  1
Affiliations
Case Reports

An Atypical Presentation of Sarcoidosis

Chelsea J Kubinec et al. Cureus. .

Abstract

Sarcoidosis is a multisystem disease characterized by non-caseating granulomatous organ infiltration. We describe an atypical presentation of sarcoidosis in a 43-year-old male presenting with fatigue and shortness of breath. He had a preceding history of recurrent venous thromboembolism (VTE), hemolytic anemia, cirrhosis, peripheral neuropathies, and calcium deposition, which pre-dated hypercalcemia; he was later diagnosed with IgA nephropathy. Clinicians should consider sarcoidosis in patients with findings of multisystem disease even without hilar lymphadenopathy or hypercalcemia.

Keywords: calcium deposition; case report; hypercalcemia; sarcoidosis; splenomegaly.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Ringrose declare(s) personal fees and stock/stock options from mmHg Inc, Astra Zeneca, Mineralys. Shareholder mmHg Inc a digital health company, conducting clinical trials with Astra Zeneca and Mineralys (not relevant to this case report). Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography.
A. Portal venous phase CT shows layering sludge and debris in the gallbladder at initial presentation in 2017 (A, long arrow). B. Subsequent un-enhanced CT performed one year later (2018) shows a dramatic change with lobulated, layering calcification along the gallbladder wall (B, short arrow).
Figure 2
Figure 2. Computed tomography.
Initial CT at presentation in 2017 (left) shows an intraureteric right renal calculus (A, long arrow) with upstream moderate hydroureter and hydronephrosis (B, short arrow).
Figure 3
Figure 3. Repeat CT in 2021, four years after initial presentation, shows development of unusual small vessel calcification within the pancreatic tail (arrow).
Figure 4
Figure 4. Chronic pulmonary embolus on initial CT (long arrow). B. Calcification of the chronic thrombus four years later (short arrow).
A. Chronic pulmonary embolus in the right interlobar pulmonary artery on initial presenting CT in 2017 (left, long arrow). B. Calcification of the chronic thrombus developed in on follow-up CT four years later (right, short arrow).
Figure 5
Figure 5. Routine hematoxylin and eosin (H&E)-stained section of endobronchial ultrasound-guided biopsy of 11R hilar node.
High-power (40×) view showing non-caseating granuloma with associated benign lymphoid cells and no evident necrosis.
Figure 6
Figure 6. Time course of case presentation.
DVT: deep vein thrombosis, TKA: total knee arthroplasty, T: thoracic, L: lumbar, PE: pulmonary embolism.
See this image and copyright information in PMC

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