Alhashimalsayed Zaki, Ladak Karim, Al-Haddad Sahar, Kraeker Christian
Department of Medicine, McMaster University, Hamilton, CAN.
Department of Pathology, McMaster University, Hamilton, CAN.
Cureus. 2023 Aug 30;15(8):e44401. doi: 10.7759/cureus.44401. eCollection 2023 Aug.
Sarcoidosis is a multisystem noncaseating granulomatous disease, which primarily involves the lungs, skin, and lymph nodes. In this case, we describe a 49-year-old Caucasian male presenting with weakness and symptomatic hypercalcemia. Initial workup revealed multiple testicular hypoechoic lesions on ultrasound and pulmonary nodules with hilar lymphadenopathy on a CT scan. Given the age of the patient, the initial differential diagnosis included lymphoma and testicular cancer. However, a lymph node biopsy confirmed the presence of noncaseating granulomas, and thus a diagnosis of multisystem sarcoidosis was made. Treatment with systemic steroids resulted in significant improvement, and he was initiated on methotrexate as a steroid-sparing agent. This case report details an unusual presentation of this multisystemic disease, which infrequently involves the genitourinary system, and presents a review of the literature on the "great imitator."
结节病是一种多系统非干酪样肉芽肿性疾病，主要累及肺、皮肤和淋巴结。在本病例中，我们描述了一名49岁的白种男性，表现为虚弱和症状性高钙血症。初步检查发现超声显示多个睾丸低回声病变，CT扫描显示肺部结节伴肺门淋巴结肿大。鉴于患者的年龄，最初的鉴别诊断包括淋巴瘤和睾丸癌。然而，淋巴结活检证实存在非干酪样肉芽肿，因此诊断为多系统结节病。全身用类固醇治疗后有显著改善，随后开始使用甲氨蝶呤作为类固醇节约剂。本病例报告详细介绍了这种多系统疾病的不寻常表现，该疾病很少累及泌尿生殖系统，并对关于“伟大模仿者”的文献进行了综述。
