Nephrolithiasis as primary symptom in sarcoidosis

Area of Science:

• Nephrology
• Pulmonology
• Rheumatology
• Immunology

Background:

• Sarcoidosis is a multisystem inflammatory disease of unknown etiology.
• Urolithiasis is a rare but recognized presentation of sarcoidosis.
• Extrapulmonary sarcoidosis, particularly in Black individuals, may manifest with atypical symptoms.

Purpose of the Study:

• To highlight the diagnostic challenge of sarcoidosis presenting exclusively as recurrent renal stones.
• To emphasize the importance of considering sarcoidosis in patients with unexplained urolithiasis.
• To underscore the diagnostic utility of angiotensin-converting enzyme levels in specific sarcoidosis cases.

Main Methods:

• Case presentation of a 30-year-old Black woman with a 1-year history of weight loss, fatigue, and recurrent renal stones.
• Diagnostic workup including physical examination, chest roentgenogram, and laboratory tests.
• Identification of lymphadenopathy leading to the diagnosis of extrapulmonary sarcoidosis.

Main Results:

• Initial investigations for recurrent renal stones were inconclusive.
• A normal chest roentgenogram did not rule out sarcoidosis.
• Detection of lymphadenopathy and elevated angiotensin-converting enzyme levels aided in diagnosing extrapulmonary sarcoidosis.

Conclusions:

• Sarcoidosis can present with urolithiasis as the sole manifestation, even with a normal chest X-ray.
• Physicians should maintain a high index of suspicion for sarcoidosis in patients with unexplained renal stones.
• Angiotensin-converting enzyme levels can be a valuable diagnostic tool in select cases of suspected sarcoidosis.