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Case Reports in Medicine
Volume 2015, Article ID 565243, 6 pages
http://dx.doi.org/10.1155/2015/565243
Case Report

Hypercalcemia, Anemia, and Acute Kidney Injury: A Rare Presentation of Sarcoidosis

1Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA
2Department of Pathology, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA

Received 18 March 2015; Accepted 14 June 2015

Academic Editor: Jagdish Butany

Copyright © 2015 Neeraj Sharma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We discuss a case of a 61-year-old woman who presented with substernal chest pain. She was found to have elevated calcium levels, anemia, and acute kidney injury. The hypercalcemia persisted despite therapy with fluids and bisphosphonates. She was found to have nonparathyroid hormone (PTH) mediated hypercalcemia. The chest X-ray did not reveal any pathology. Our Initial impression was likely underlying hematologic malignancy such as lymphoma or multiple myeloma. A bone marrow biopsy was performed that revealed nonnecrotizing granulomatous inflammation. Further workup revealed elevated vitamin 1,25 dihydroxy level, beta-two microglobulin level, and ACE levels. Noncontrast computed tomography (CT) scan of chest showed bilateral apical bronchiectasis, but did not show any lymphadenopathy or evidence of malignancy. Subsequently, a fiber optic bronchoscopy with transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. After initiating glucocorticoid therapy, the patient’s hypercalcemia improved and her kidney function returned to baseline.