SHM Converge Scientific Abstract ePoster Gallery-Distinguishing Features and Diagnostic Challenges in Elderly-Onset Sarcoidosis

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This case describes a 72-year-old man with 6 months of progressive weakness, major weight loss, fatigue, confusion, and a recent week of fevers. His history included hypertension, HFpEF, CKD stage III, nephrolithiasis, atrial fibrillation, peptic ulcer disease, recurrent hypercalcemia, pancytopenia, and cirrhosis of unclear cause. Exam showed an ill-appearing, lethargic patient with mild confusion.<br /><br />Admission workup revealed pancytopenia, severe hypercalcemia, low PTH, elevated 1,25-OH vitamin D, low 25-OH vitamin D, and markedly elevated ACE level. HIV and TB testing were negative. Chest X-ray did not show classic hilar adenopathy, highlighting the diagnostic challenge. Because elderly-onset sarcoidosis often presents with nonspecific constitutional symptoms and extrapulmonary disease, malignancy and infection had to be excluded.<br /><br />The case emphasizes that elderly-onset sarcoidosis is uncommon and less well characterized than young-onset sarcoidosis, with an estimated incidence under 4.6–6.5 per 100,000. Its presentation is often insidious and dominated by vague systemic symptoms, making diagnosis difficult. Tissue biopsy is frequently needed, and comorbidities in older patients can complicate treatment decisions.<br /><br />The patient was treated with prednisone 40 mg daily followed by a gradual taper, plus hydroxychloroquine 400 mg daily. At 2-month follow-up, he had improved clinically with resolution of fevers, fatigue, and weakness, weight gain, and improving lab abnormalities including hypercalcemia, vitamin D levels, and ACE.<br /><br />Key takeaways: elderly-onset sarcoidosis can look very different from typical younger-onset disease, diagnosis often requires biopsy and exclusion of other causes, and treatment must account for side effects in older adults with multiple comorbidities.

Asset Subtitle

Austin M. Keller

Meta Tag

Author List Adam Attaar, Austin M. Keller

Category Clinical Vignettes

Concept Sarcoidosis

Concept Elderly-Onset Sarcoidosis

Concept Hypercalcemia

Concept Infectious Disease

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization Northwestern University Feinberg School of Medicine - Department of Medicine

Presenting Author Austin M. Keller

Track Adult

Keywords

elderly-onset sarcoidosis

hypercalcemia

pancytopenia

weight loss

fatigue

confusion

elevated ACE

prednisone

hydroxychloroquine

extrapulmonary disease

Sarcoidosis

Elderly-Onset Sarcoidosis

Hypercalcemia

Infectious Disease

Malignancy