A syndrome resembling Bartter's syndrome in sarcoidosis

Acquired Bartter-like syndrome, albeit rare, has not been reported to be associated with sarcoidosis. We describe the case of a 32-year-old male patient who presented with progressive muscular weakness of both lower extremities. Profound hypokalaemia associated with renal (K(+)) wasting, bilateral nephrocalcinosis and high plasma renin activity resembled Bartter's syndrome (BS). Both mediastinal lymph node and renal biopsy demonstrated sarcoidosis with non-caseating granuloma. Genetic testing responsible for hereditary BS or Gitelman's syndrome (GS) was negative. Hypokalaemia was well controlled with the administration of spironolactone with oral steroids and KCl. Early recognition and prompt treatment of sarcoidosis-associated Bartter-like syndrome avoids unnecessary complications.