Adhikari Bipin, Adhikari Biplab, Kanugula Ashok Kumar, Parajuli Prekshya, Singh Sonu
Internal Medicine, Wellstar Spalding Medical Center, Griffin, USA.
Internal Medicine, University of Louisville, Louisville, USA.
Cureus. 2024 Aug 17;16(8):e67092. doi: 10.7759/cureus.67092. eCollection 2024 Aug.
The cause of sarcoidosis is unknown, and it affects multiple systems with granulomas. Lung lesions are typical, but extrapulmonary findings, especially lymphadenopathy, are present in a significant number of cases. Isolated renal involvement is rare. The presence of noncaseating granulomas on biopsy is a hallmark of sarcoidosis. We present the case of a 59-year-old male with recurrent renal stones who presented with renal failure. The initial diagnosis was challenging due to normal chest imaging and no pulmonary involvement. However, his delayed presentation of calcinosis cutis, an increase in angiotensin-converting enzyme (ACE) level, and the biopsy of the palm lesion with noncaseating granulomas helped us reach the diagnosis. He was started on prednisolone and achieved remission. The report also intends to show that patients with sarcoidosis can present without lung involvement, and physicians should consider sarcoidosis as their differential diagnosis for idiopathic hypercalcemia even if it has no lung or skin findings.
结节病的病因不明，它会影响多个系统并形成肉芽肿。肺部病变很典型，但在相当多的病例中存在肺外表现，尤其是淋巴结病。孤立的肾脏受累情况罕见。活检时出现非干酪样肉芽肿是结节病的一个标志。我们报告了一例59岁男性复发性肾结石伴肾衰竭的病例。由于胸部影像学检查正常且无肺部受累，最初的诊断颇具挑战性。然而，他迟发性皮肤钙化、血管紧张素转换酶（ACE）水平升高以及手掌病变活检发现非干酪样肉芽肿，这些帮助我们做出了诊断。他开始使用泼尼松龙治疗并实现了缓解。该报告还旨在表明，结节病患者可能无肺部受累表现，即使没有肺部或皮肤表现，医生在诊断特发性高钙血症时也应将结节病列为鉴别诊断之一。
