In rare cases of sarcoidosis, patients may have high blood calcium levels (hypercalcemia), scarring on the scalp, and kidney failure, according to a new report.
The case report, titled “Symptomatic hypercalcemia and scarring alopecia as presenting features of sarcoidosis,” was published in the journal Baylor University Medical Center Proceedings.
Sarcoidosis is a disease characterized by the presence of abnormal collections of inflammatory cells that form lumps known as granulomas.
It is a multisystemic disease, usually beginning in the lungs, skin, or lymph nodes, and is slightly more common in women, with a higher incidence in African-Americans compared to Caucasians.
Many sarcoidosis patients tend to have an irregular calcium metabolism, and are generally affected with hypercalciuria — elevated levels of calcium in urine.
Less commonly, some sarcoidosis patients develop hypercalcemia, which is high calcium levels in the blood.
Hypercalcemia is reported in 10 to 20 percent of patients with sarcoidosis and is generally asymptomatic. Symptomatic hypercalcemia is seen in fewer than 5 percent of patients.
While sarcoidosis can often affect the skin, it generally does not affect the scalp.
In this case report, physicians detail the case of a patient with sarcoidosis who had symptomatic hypercalcemia, scarring alopecia (hair loss) on the scalp, and acute-on-chronic kidney failure.
The patient, a 60-year-old African-American woman, arrived at the emergency department of Baylor University Medical Center in Dallas, Texas, with motor weakness and altered mental status.
She had prior diagnoses of hypertension, chronic bronchitis, intellectual impairment, and schizophrenia. The patient’s caregiver reported a worsening cough, confusion, and progressive muscle weakness which prevented the patient from getting out of bed.
A physical examination of the patient’s scalp revealed alopecia and a large, 20-cm scaly plaque as well as a smaller 4-cm scaly plaque.
Lung abnormality was noted, although results for tuberculosis were negative. Other laboratory results revealed high calcium levels in the blood. The patient was started on intravenous fluids (0.9% normal saline) and calcitonin, a hormone that helps regulate calcium levels.
Subsequent tests revealed that the patient had sarcoidosis, and was administered 40 mg of the corticosteroid Solu-Medrol (methylprednisolone) every eight hours, along with continued treatment with calcitonin.
Over 11 days, the patient’s blood calcium levels dropped from 14.5 mg/dL to 10.6 mg/dL, which is closer to the normal range. The levels of creatinine, a molecule that indicates renal dysfunction, also decreased. The patient was then discharged.
Although treatment with corticosteroids did lead to an improvement in hypercalcemia and renal dysfunction, kidney function was not fully restored, likely due to chronic kidney damage.
The kidney damage was, at least in part, likely associated with hypercalcemia, as it can often lead to renal failure. The renal damage may also be a result of sarcoidosis in the kidneys, though no kidney biopsy was conducted to confirm this.
“Unique features of this case include scarring alopecia secondary to sarcoidosis and severe and symptomatic hypercalcemia,” the researchers wrote.
They also noted that it is important to monitor disease activity as relapses can often occur, even if a person is initially responsive to corticosteroids.
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