A 56-year-old woman with sarcoidosis and acute renal failure

Abstract

CASE PRESENTATION A 56-year-old Hispanic woman with a history of sarcoidosis came to the Emergency Department complaining of bilateral leg pain. One year before admission, she had presented to another hospital with shoulder pain and weight loss. At that time, she was found to have hypercalcemia and acute renal failure. Computed tomography of the chest revealed mediastinal and hilar lymphadenopathy, and a transbronchial needle biopsy was consistent with sarcoidosis. She was treated with intravenous fluids, a bisphosphonate, and steroids, which were tapered off over 2 months. Her creatinine level decreased from 4.5 to 1.3 mg per 100 ml. One month before admission, she had been checked by a primary care doctor for a routine visit, and lab tests included a creatinine level of 5.1 mg per 100 ml. Past medical history was also notable for hypertension and a hysterectomy. Her medications included amlodipine and intermittent naproxen (she reported only having taken four pills recently of naproxen). Physical examination revealed a well-appearing woman. The blood pressure was 132/82 and there was mild diffuse tenderness on palpation of her legs bilaterally. There was no rash. Her lungs were clear. The heart was regular in rate and rhythm with no murmurs, rubs, or gallops. No lymphadenopathy or hepatosplenomegaly was appreciated. There was no lower extremity edema. Laboratory values and radiology results are shown in Table 1. She was initially treated with intravenous fluids and furosemide. Her calcium level was normalized, but her creatinine level continued to rise. A renal biopsy was performed.