Puzzling hypercalcaemia: sarcoidosis without lung involvement
A Caucasoid woman of 68 was seen after three weeks of confusion, polydipsia, anorexia, general malaise and weight loss. A life-long smoker of ten cigarettes a day, she had no medical history of note. On examination she was cachectic and dehydrated. Nothing else was found—in particular, no rashes, lymphadenopathy, or respiratory or neurological signs. Routine investigations revealed a lymphopenia of 0.66109/L (full blood count otherwise normal), erythrocyte sedimentation rate 34 mm/h, normal serum electrolytes with mild renal impairment (urea 12.1 mmol/L, creatinine 164 mmol/L) and hypercalcaemia with a corrected serum total calcium of 3.56 mmol/L and phosphate 1.3 mmol/L; alkaline phosphatase was 165 IU/L, alanine aminotransferase 44 IU/L, gammaglutamyltransferase 81 IU/L, and albumin 30 g/L. Her chest radiograph was normal.