Hipercalcemia recurrente en un paciente con sarcoidosis aguda

sarcoidosis is a chronic granulomatous disease of unknown etiology characterized by the presence of noncaseating epithelioid granulomas that can take place in every organ or system of the human body. this disease can be acute or sub acute and self limited in presentation or can have a chronic course characterized by exacerbations and remi-ssions. hypercalcemia can be detected in 10 to 20 percent of the patients with the disease. it is caused by the over expression of vitamin d-receptor and 25-hydroxyvitamin d 1-α hydroxilase enzyme in monocytes and activated macrophages within the granuloma in a way that is resistant to the natural inhibition driven by high serum calcium levels. this autonomous enzymatic activity leads to the overproduction of calcitriol which increase intestinal absorption of the calcium present in the diet and also increase the activity of osteoclast with consequent high bone turnover and hypercalcemia. in this report we present the case of a 49 years old man, black race, bilateral parotid gland enlar-gement, bilateral hilar lymphadenopathy, severe recurrent hypercalcemia and acute renal failure in who sarcoidosis was documented as the cause of his symptoms.