2020 Volume 53 Issue 1 Pages 35-42
The patient, a 55-year-old, was started on hemodialysis at the age of 51, after undergoing nephrectomy for a right renal tumor. She started taking oral alfacalcidol after 2 months of hemodialysis. After undergoing hemodialysis for 4 years, she was hospitalized for a subcutaneous lumbar mass and hypercalcemia, which persisted after the discontinuation of alfacalcidol. Sarcoidosis was diagnosed based on her high serum lysozyme level, the abnormal accumulation exhibited by the mass on gallium scintigraphy, and the fact that a biopsy of the mass revealed that it was a non-caseating epithelioid granuloma. Steroid treatment improved the hypercalcemia and subcutaneous mass. It was suggested that the sarcoidosis had been present for a while because pathologically both a previous brain tumor and the renal tumor were epithelioid granulomas. Furthermore, active vitamin D has been reported to promote the formation of epithelioid granulomas and to affect the pathogenesis of sarcoidosis. It is suggested that the sarcoidosis in this case might have been related to the administration of an active vitamin D preparation.
