Sarcoidosis Masquerading as Adjustment Disorder: A Case Report of Hypercalcemia-Induced Altered Sensorium

Sarcoidosis is a multisystem granulomatous disease that can present with nonspecific symptoms and, rarely, with severe hypercalcemia and neurological manifestations. We report a case of a 55-year-old female with systemic hypertension, type 2 diabetes mellitus, and hypothyroidism, who presented with reduced appetite for five months, altered sensorium for three months, and difficulty rising from bed. Initial evaluation elsewhere diagnosed adjustment disorder. On further workup, she was found to have marked hypercalcemia (serum calcium = 16.7 mg/dL), renal dysfunction (creatinine = 3.7 mg/dL), and a chest X-ray showed hilar lymphadenopathy. Positron emission tomography-computed tomography revealed periportal and mediastinal lymphadenopathy. Endobronchial ultrasound-guided biopsy showed necrotizing granulomatous inflammation. Acid-fast bacillus testing was negative, and serum angiotensin-converting enzyme levels were elevated. A diagnosis of sarcoidosis was made. The patient was treated with intravenous fluids, correction of electrolyte imbalance, and corticosteroids. Clinical improvement was observed with normalization of mental status and renal function within three days. This case highlights the importance of considering sarcoidosis as the underlying cause of hypercalcemia in a patient with neurological symptoms such as depression. Early recognition and treatment can prevent long-term complications.