SHM Converge Scientific Abstract ePoster Gallery-An Atypical Presentation of Sarcoidosis Limited to the Bone Marrow

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This case describes an 80-year-old man with type 2 diabetes and stage III chronic kidney disease who presented with generalized weakness, falls, weight loss, and constipation. Initial evaluation showed hypercalcemia, acute worsening of kidney function, anemia, and thrombocytopenia. Over three prolonged hospitalizations, clinicians investigated common causes such as malignancy, infection, and monoclonal gammopathy, but chest CT, kidney ultrasound, blood cultures, serum/urine electrophoresis, and PET/CT were unrevealing. Laboratory findings showed suppressed PTH, normal PTHrP, and normal vitamin D levels, making typical causes of hypercalcemia less likely.<br /><br />Because of persistent hypercalcemia, elevated creatinine, and bicytopenia, a hematologic malignancy was suspected. A bone marrow biopsy was ultimately performed and revealed non-necrotizing epithelioid granulomas with negative GMS and AFB stains, excluding fungal and mycobacterial infection. Serum ACE was normal, but soluble IL-2 receptor was elevated, supporting sarcoidosis. Based on the clinical and pathologic findings, the patient was diagnosed with isolated bone marrow sarcoidosis.<br /><br />The report emphasizes that sarcoidosis is usually a clinical diagnosis but can be supported by serum markers, imaging, and biopsy. However, isolated bone marrow involvement is rare, especially without pulmonary disease, and can be difficult to detect because serum ACE has limited diagnostic value and PET/CT may miss lesions. This case highlights the importance of considering extrapulmonary sarcoidosis in patients with unexplained hypercalcemia, cytopenias, and renal dysfunction, even when standard testing is negative. The authors stress that increased awareness and better diagnostic strategies are needed to identify sarcoidosis limited to the bone marrow earlier.

Asset Subtitle

Lisa Kojima

Meta Tag

Author List Amy Teleron, Celeste Santos-Martins, Katie Shen, Lisa Kojima

Category Clinical Vignettes

Concept Sarcoidosis

Concept Bone Marrow Sarcoidosis

Concept Noncaseating Granuloma

Concept Extrapulmonary Sarcoidosis

Concept Tissue Biopsy

Distinguished Finalist

Presenter Organization Cleveland Clinic Lerner College of Medicine

Presenting Author Lisa Kojima

Track Adult

Keywords

bone marrow sarcoidosis

hypercalcemia

chronic kidney disease

anemia

thrombocytopenia

non-necrotizing granulomas

soluble IL-2 receptor

suppressed PTH

extrapulmonary sarcoidosis

renal dysfunction

Sarcoidosis

Bone Marrow Sarcoidosis

Noncaseating Granuloma

Extrapulmonary Sarcoidosis

Tissue Biopsy