Sarcoidosis With Generalized Lymphadenopathy: A Clinical Mimic of Lymphoma

Sarcoidosis is a multiorgan disease characterized by noncaseating granulomatous lesions, most commonly affecting the lungs. It typically presents with cough, dyspnea, wheezing, and chest pain. Chest X-rays often show bilateral hilar adenopathy. Extrapulmonary symptoms are also common. However, diagnosis requires ruling out other potential causes. We present a case of a 58-year-old African-American woman with diabetes mellitus who presented with right flank pain and was found to have elevated creatinine (4.4 mg/dL) and severe hypercalcemia (15.3 mg/dL). Imaging revealed extensive lymphadenopathy, leading to suspicion of lymphoma. A comprehensive workup, including lymph node biopsy, ruled out lymphoma, and sarcoidosis was diagnosed. The patient was treated with intravenous (IV) hydration, calcitonin, and pamidronate for hypercalcemia, with subsequent normalization of calcium and improvement in creatinine levels. A lymph node biopsy confirmed granulomatous disease consistent with sarcoidosis. Flow cytometry showed no evidence of lymphoma, and the patient was started on prednisone. Sarcoidosis presents a diagnostic challenge due to its varied presentation and the need for more sensitive and specific diagnostic tests, often leading to under-recognition and misdiagnosis. Studies have found that most patients with pulmonary sarcoidosis also have extrapulmonary involvement, with extrathoracic lymph nodes and skin being the most commonly affected sites. Sarcoidosis-lymphoma syndrome should also be considered, as the incidence of lymphoma is higher in patients with sarcoidosis. However, it can be missed due to similar presentations and a need for more awareness, impacting patient care and prognosis. Our case emphasizes the importance of accurately diagnosing sarcoidosis and ruling out lymphoma and other lymphoproliferative diseases, given their increased incidence in sarcoidosis patients. However, treatment for lymphoma should not be initiated until the diagnosis is confirmed, as sarcoidosis can mimic lymphoma.