A case of malignant hypertension due to sarcoidosis

Sarcoidosis is a systemic inflammatory disease that is difficult to diagnose. This report describes a 54-year-old man who presented with an incidental finding of abnormal hilar shadows on imaging, indicating sarcoidosis. During follow-up, he experienced a sudden blood pressure increase (210/140 mmHg) accompanied by headaches, nausea, hypertensive retinopathy, and renal dysfunction, diagnosed as malignant hypertension. Contrast-enhanced computed tomography (CT) revealed wedge-shaped areas of poor enhancement in both kidneys, suggesting impaired perfusion due to interlobar artery compression. Renal biopsy showed noncaseating epithelioid cell granulomas, confirming renal sarcoidosis. After prednisolone treatment, the active renin concentration decreased from 265 pg/ml to 89 pg/ml, and the renal perfusion abnormalities improved on repeat CT. Renovascular hypertension due to sarcoidosis nodules disrupting the interlobar artery strongly suggests the cause of malignant hypertension. This is the first reported case of malignant hypertension due to renal sarcoidosis. Therefore, sarcoidosis should be considered as a differential diagnosis in patients with malignant hypertension.