Hypercalcemic Crisis and Severe Renal Failure Due to Sarcoidosis Followed by Autoimmune Thrombocytopenia on Remission: A Case of Drug-Refractory and Chronic Disease

ABSTRACT

A 70-year-old woman, with a history of type II diabetesmellitus, presented with a 1-month history of progressiveweakness, disorientation and decrease appetite. She wasfound to have high serum calcium at 3.4 mmol/L and severerenal failure with serum creatinine at 700 umol/L. She hadnormal kidney ultrasound, vitamin D2, parathyroid hormoneand negative Quantiferon and Brucella tests. PET scanshowed increase uptake in the paratracheal lymph nodes.Mediastinoscopic lymph node biopsy disclosed non-caseatinggranulomata. Serum calcium and subsequently her acuterenal failure had improved with corticosteroids. She could nottolerate Azathioprine, Cyclophosphamide, andMycophenolate for severe gastrointestinal side effects.Moreover, her disease did not respond to Cyclosporine A,Methotrexate, Hydroxychloroquine and Rituximab.Ultimately, she was kept on Prednisone 20 mg daily as along-term maintenance therapy. Eight months afterremission, she developed severe thrombocytopenic purpura.Fortunately, the latter was controlled with temporary increasein her corticosteroid dose for 6 weeks. After 2 years oftreatment, she had spontaneous remission and Prednisonewas discontinued. No relapse was reported 1 year later. Inconclusion: Sarcoidosis can induce hypercalcemic crisis,acute renal failure and thrombocytopenia with activity up to 2years and treatment limited only to Corticosteroids.