A case of muscle sarcoidosis with hypercalcemia, lower limb muscle strength and without bilateral hilar lymphadenopathy

Abstract

A 73-year-old man was hospitalized with complaints of general malaise, limb muscle weakness and weight loss progressing in 6 months. Ca, ACE, lysozyme, sIL-2R, vitamin 1.25 D was high in the blood test. Bilateral hilar lymphadenopathy on CT were not recognized, and CD4/CD8 ratio increased by bronchoalveolar lavage. In the ⁶⁷Ga-citrate scintigraphy, accumulation was observed on the thigh and shoulder to the upper arm bilaterally. A muscle biopsy was performed from the right femoris muscle where the gadolinium contrast effect in the T₁ weighted image was observed. As muscle biopsy revealed non-toxic epithelial cell granulomas, he was diagnosed as muscle sarcoidosis. Even if bilateral hilar lymphadenopathy is not observed, muscle sarcoidosis should be considered in patients developed with hypercalcemia and limb muscle weakness.