[Hypercalcemia revealing sarcoidosis in a child]

Area of Science:

• Pediatric Rheumatology
• Pediatric Endocrinology
• Systemic Granulomatous Diseases

Background:

• Sarcoidosis is a rare systemic granulomatous disease, particularly in children.
• Hypercalcemia is an uncommon but significant presentation of pediatric sarcoidosis.
• The classic diagnostic triad for sarcoidosis may not always be present in pediatric cases.

Observation:

• A 14-year-old boy presented with symptoms suggestive of bone marrow and lymph node sarcoidosis, accompanied by hypercalcemia.
• Literature review included 23 pediatric cases of sarcoidosis with hypercalcemia since 1990.
• Younger children with hypercalcemia as an initial symptom were diagnosed more readily.

Findings:

• Hypercalcemia in children can be a key indicator for sarcoidosis, especially when classical signs are absent.
• Common sarcoidosis locations like lungs, skin, and lymph nodes aid in diagnosis.
• Treatment with hydration, diuretics, bisphosphonates, and corticosteroids showed positive outcomes.

Implications:

• Sarcoidosis diagnosis in children is challenging due to rarity and nonspecific symptoms, often leading to delays.
• Systematic investigation for sarcoidosis is recommended in children with unexplained hypercalcemia.
• Increased awareness can improve diagnostic timelines and patient outcomes for pediatric sarcoidosis.