Hypercalcemia: An Underestimated Value Always Good for a Surprise

Area of Science:

• Internal Medicine
• Rheumatology
• Neurology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
• Muscular involvement in sarcoidosis is uncommon, often presenting with nonspecific symptoms.
• Hypercalcemia can be a manifestation of sarcoidosis, necessitating thorough investigation.

Observation:

• A 62-year-old male presented with severe asthenia and dyspnea.
• Blood tests revealed marked hypercalcemia, initially prompting suspicion of malignancy.
• 18F-FDG PET-CT demonstrated widespread muscular metabolic activity, indicative of an inflammatory process.

Findings:

• Muscle biopsy confirmed non-necrotizing granulomas with multinucleated giant cells.
• The findings were pathognomonic for acute isolated muscular sarcoidosis.
• The patient experienced significant clinical improvement and normalization of serum calcium levels following treatment.

Implications:

• This case underscores the importance of considering sarcoidosis in the differential diagnosis of unexplained hypercalcemia and severe asthenia.
• Early diagnosis and appropriate management, including high-dose steroid therapy, are crucial for favorable outcomes in muscular sarcoidosis.
• Highlighting rare presentations of sarcoidosis expands diagnostic awareness in clinical practice.