A Case of Renal Sarcoidosis: A Diagnostic Dilemma

Abstract

Sarcoidosis is a multi-system disease of unknown aetiology, characterised by non-caseating granulomas. It can involve any organ in the body, but commonly affects the lungs and lymph nodes. The worldwide prevalence of sarcoidosis is 20-60 per/100,000 and people, while in India, it is 61.2 per 100,000. The probable cause is an inflammatory response triggered by various environmental agents in genetically sensitive individuals. Approximately one-third of patients with sarcoidosis remain asymptomatic. Typical symptoms include non-specific pulmonary symptoms such as cough, dyspnoea and chest pain. Cutaneous or ocular manifestations may include malar rash, erythema nodosum, keratoconjunctivitis, anterior uveitis and chorioretinitis. The presence of hilar lymphadenopathy on chest X-ray is highly suggestive of sarcoidosis. In this case, a 68-year-old female patients, presented with complaints of anorexia and fatigue for the past three months. She was found to have anaemia, hypercalcaemia, and abnormal renal function. Abdominal ultrasonography (USG) showed normal findings. The patient was initially evaluated for Tuberculosis (TB) and started on empirical Anti-Tubercular Therapy (ATT). However, as the patient did not show any improvement, further evaluation was conducted, leading to a diagnosis of sarcoidosis. Treatment options for sarcoidosis include systemic steroids, immunosuppresants, and cytotoxic drugs. Biologics such as anti-Tumour Necrosis Factor (TNF) agents (etanercept, golimumab, and infliximab) have also been considered in the treatment. Sarcoidosis can present a diagnostic dilemma as seen in this patient who initially had features resembling disseminated TB. This highlights the importance of strong clinical suspicion by the treating physician and thorough evaluation.