Symptomatic hypercalcemia and lytic lesions of the skull revealing sarcoidosis: A case report

Sarcoidosis is a systemic granulomatosis of unknown etiology. Mediastinal lymph node and pulmonary involvement are the most characteristic manifestations. However, bone involvement is rare during sarcoidosis. Herein, we describe an atypical case of sarcoidosis revealed by a severe hypercalcemia and lytic lesions of the skull without pulmonary or mediastinal manifestation. A 53-year-old woman was admitted for symptomatic hypercalcemia of 3.8 mmoL/L. The initial good course after hydration combined with a dose of intravenous zoledronate was followed by a relapse of hypercalcemia. Computed tomography (CT) scan showed 2 lytic lesions of the skull and multiple nodules and micronodules in the liver and the spleen which were of normal size. The histological examination showed a non-necrotizing granulomatous hepatitis, with no signs of malignancy. The bone marrow biopsy did not show any abnormality. Assessment for tuberculosis was negative. The diagnosis of sarcoidosis was considered. Oral prednisone therapy allowed total remission.