Nageshwaran Sathiji, Majumdar Kalpita, Russell Sabina
Department of General Medicine, Chase Farm Hospital, Middlesex, UK.
BMJ Case Rep. 2012 Jun 21;2012:bcr0120125478. doi: 10.1136/bcr.01.2012.5478.
A 53-year-old Afro-Caribbean woman presented to casualty with a constellation of symptoms pointing to a diagnosis of hypercalcaemia. This was confirmed on laboratory investigation. Findings of a raised serum protein (108 g/l) and normal albumin (35 g/l), lead to an initial working diagnosis of multiple myeloma. However, later serum protein electrophoresis found a polyclonal gammopathy and further investigation lead to a diagnosis of sarcoidosis. The patient responded well to conventional treatment with oral prednisolone. A number of learning points have been highlighted including the pitfalls of pattern recognition in diagnosis and the various manifestations of systemic sarcoidosis. A brief review of the history and various manifestations of sarcoidosis including the pathophysiology of hypercalcaemia in sarcoidosis are presented as well as of polyclonal gammopathy.
一名53岁的非洲加勒比裔女性因一系列指向高钙血症诊断的症状前往急诊。实验室检查证实了这一诊断。血清蛋白升高（108 g/l）而白蛋白正常（35 g/l）的检查结果，初步诊断为多发性骨髓瘤。然而，后来的血清蛋白电泳发现是多克隆丙种球蛋白病，进一步检查后诊断为结节病。患者对口服泼尼松龙的传统治疗反应良好。强调了一些学习要点，包括诊断中模式识别的陷阱以及系统性结节病的各种表现。本文简要回顾了结节病的病史和各种表现，包括结节病中高钙血症的病理生理学以及多克隆丙种球蛋白病。
