Unveiling the Silent Clue: Asymptomatic Hypercalcemia Revealing Sarcoidosis

Summary: This is a case of a 59-year-old male who presented to the emergency department after being referred by his primary care physician for evaluation of hypercalcemia. At the time of presentation, the patient was asymptomatic and reported that his laboratory results from approximately one year prior had been within normal limits. He denied any new medications, weight loss, night sweats, or a history of malignancy. Further investigations revealed newly diagnosed renal dysfunction and elevated total alkaline phosphatase. Chest imaging showed innumerable irregular nodules scattered throughout both lungs, along with bilateral hilar lymphadenopathy. Additionally, abdominal imaging identified multiple ill-defined nodular lesions throughout the liver parenchyma. Given these findings, sarcoidosis became a strong consideration; however, malignancy and other potential causes of hypercalcemia needed to be ruled out. Extensive workup, including cancer tumor markers, parathyroid hormone levels, HIV testing, and a vasculitis panel, was unremarkable. Although a biopsy was not performed during the initial hospitalization, the patient later underwent a transbronchial biopsy with his pulmonologist. Histopathological analysis confirmed the presence of noncaseating granulomas, establishing the diagnosis of sarcoidosis.