Sarcoid Nodular Myopathy Presenting With Hypercalcemia: A Rare Presentation-Case Report

Area of Science:

• Internal Medicine
• Rheumatology
• Endocrinology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
• Extrapulmonary sarcoidosis can present with diverse symptoms, sometimes mimicking other conditions.
• Hypercalcemia is a known, albeit uncommon, manifestation of sarcoidosis.

Purpose of the Study:

• To report a rare case of sarcoidosis presenting with nonanginal chest pain and a thigh mass.
• To illustrate the diagnostic challenges and successful management of extrapulmonary sarcoidosis.
• To emphasize the importance of considering sarcoidosis in patients with unexplained hypercalcemia and systemic symptoms.

Main Methods:

• A case report of an 18-year-old female with new-onset chest pain and thigh mass.
• Diagnostic workup included physical examination, laboratory tests (calcium, parathyroid hormone, 25-(OH) Vitamin D, angiotensin-converting enzyme), and imaging (CT chest).
• A core needle biopsy of the thigh mass was performed for histopathological analysis.

Main Results:

• The patient presented with chest pain, a palpable thigh mass, edema, and elevated serum calcium (12.5 mg/dL).
• Biopsy revealed findings suggestive of sarcoidosis, confirmed by elevated angiotensin-converting enzyme levels.
• Pulmonary involvement was absent on CT scan. Treatment with prednisolone led to symptom resolution and normalization of calcium levels within one month.

Conclusions:

• Sarcoidosis can manifest with extrapulmonary symptoms such as chest pain and soft tissue masses.
• Hypercalcemia in the context of suspected sarcoidosis warrants thorough investigation and management.
• Early diagnosis and corticosteroid therapy are effective in managing symptomatic sarcoidosis.