SARCOIDOSIS: HOW ITS DIAGNOSIS MIGHT REVEAL TROUBLED

MARIA LORETA DE GIORGI*, LUCA SGARABOTTO*, MONICA SIMEONE*, VERA BONELL*, VALERIA MAFFEIS**, FEDERICO NALESSO*, UGO VERTOLLI*, LORENZO A CALÒ*

*Department of Medicine (DIMED), Nephrology, Dialysis and Transplantation Unit, University of Padova-Azienda Ospedaliera Padova, - **Department of Pathology, University of Padova, Italy

Introduction: Sarcoidosis is a systemic inflammatory disease characterized by the presence of non-necrotic granulomas. Affected sites commonly include lungs, skin, liver, heart and lymph nodes. Sarcoidosis association with monoclonal gammopathy of undetermined significance (MGUS) is a rare finding with only 11 cases reported.

Case presentation: We report the case of a 70 yo female who, in the last two years, was repeatedly admitted at several Internal Medicine Units with generalized weakness, fever, anemia, stage 4 chronic renal failure, hypertension, type 2 diabetes, ischemic heart disease. At the last admission in our Unit the patient was anemic, with Chronic Renal Failure, hypercalcemic, with a monoclonal component IgG mounting lambda chains, heavy proteinuria. Hypercalcemia presented for the first time. Biopsy of a supraclavear node showed not necrotic granuloma-gigantic cellular inflammation, mimicking sarcoid. These latter together with chest computed tomography (CT) picture allowed the diagnosis of sarcoidosis.

Conclusion: Hypercalcemia was the most important clue to led to diagnosis, while the higher level of 1,25 Vitamin D that is part of sarcoidosis picture, was lacking and there was the presence of a plasma cell disorder, making the clinical picture more difficult to interpret. However, the presence of subtle abnormalities in repeated chest X rays performed at the accesses to Internal Medicine Units, in addition to the clinical symptoms and even in the absence of hypercalcemia, could have raised the suspect and driven the performing of a more accurate imaging analysis (chest CT), which could have allowed the diagnosis earlier.