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Nuevo diagnóstico de sarcoidosis después de un evento de falta de respuesta durante la hemodiálisis
Alisha Patel1, Jacob Boccucci2, Cameron Liss1
1Medical College of Georgia, Augusta, GA, USA.
Journal of investigative medicine high impact case reports
|August 27, 2025
Resumen
La sarcoidosis, una enfermedad sistémica, puede presentarse con síntomas extrapulmonares como hipercalcemia y encefalopatía, lo que complica el diagnóstico de enfermedad renal en etapa terminal. Este caso pone de relieve el desafío de diagnóstico de la sarcoidosis en pacientes con ESRD.
Área de la Ciencia:
- Nefrología
- Pulmonología
- Enfermedades sistémicas
Sus antecedentes:
- La sarcoidosis es una enfermedad inflamatoria sistémica caracterizada por granulomas no casados.
- Las manifestaciones extrapulmonares de la sarcoidosis a menudo imitan otras afecciones, retrasando el diagnóstico.
- Los pacientes con enfermedad renal terminal pueden presentar hipercalcemia y encefalopatía, indicadores potenciales de sarcoidosis.
Objetivo del estudio:
- Informar de un caso de sarcoidosis diagnosticado en un paciente con enfermedad renal terminal.
- Para resaltar los desafíos de diagnóstico planteados por la sarcoidosis extrapulmonar en pacientes en estado crítico.
- Para enfatizar la importancia de un diagnóstico diferencial amplio en casos médicos complejos.
Principales métodos:
- Informe de caso de un hombre de 53 años con ESRD que no respondió durante la hemodiálisis.
- El trabajo inicial incluyó pruebas de laboratorio, imágenes (TC) y lavado broncoalveolar.
- El diagnóstico fue confirmado por una biopsia endobronquial guiada por ultrasonido que reveló granulomas no necrotizantes.
Principales resultados:
- El paciente presentó hipotermia, taquicardia, leucocitosis, trastornos metabólicos, hipercalcemia y encefalopatía.
- Se trató la infección (Staphylococcus aureus), pero los síntomas persistieron.
- El aumento de la vitamina D 1,25-OH y los resultados de las imágenes y la biopsia confirmaron la sarcoidosis.
- El tratamiento con metilprednisolona condujo a la mejora de los niveles de calcio y la mentalización.
Conclusiones:
- La sarcoidosis puede presentarse de manera insidiosa en pacientes con ERES, imitando otras afecciones.
- Un alto índice de sospecha y un estudio exhaustivo son cruciales para el diagnóstico de la sarcoidosis en casos complejos.
- El diagnóstico y el tratamiento tempranos de la sarcoidosis son vitales para prevenir complicaciones graves.
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