CHEST Guidelines-A-Case-of-Thrombotic-Microangiopathy-and-Acute-Sar

A-Case-of-Thrombotic-Microangiopathy-and-Acute-Sar

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This article details a case study involving a 31-year-old male patient who presented with unusual and severe symptoms, leading to a diagnosis of thrombotic microangiopathy (TMA) and acute sarcoidosis. Initially, the patient exhibited symptoms including hypercalcemia, pancreatitis, acute renal failure, and microangiopathic hemolytic anemia, without significant respiratory issues. Despite lacking typical respiratory symptoms, thoracic radiology and mediastinal lymph node biopsy indicated sarcoidosis.<br /><br />Initially presenting with epigastric pain, nausea, and fatigue, the patient had an episode of severe diarrhea three weeks prior. Medical history revealed smoking habits, but no known significant medical conditions or drug use. Laboratory tests showed acute kidney injury, hypercalcemia, anemia, thrombocytopenia, and microangiopathic hemolytic anemia. Imaging revealed lung changes, lymphadenopathy, and splenomegaly, confirming the multisystem involvement.<br /><br />Biopsies revealed granulomatous inflammation consistent with sarcoidosis, despite the absence of renal granulomata. No infective or autoimmune causes were identified. Genetic tests ruled out atypical hemolytic uremic syndrome, and tests for Shiga toxin were negative.<br /><br />The treatment involved corticosteroids, leading to clinical improvement in symptoms and biochemical markers. This case exemplifies the need for considering sarcoidosis in complex presentations with multiorgan involvement and supports early multidisciplinary engagement for effective management. The article emphasizes that sarcoidosis-driven hypercalcemia may have triggered pancreatitis, which subsequently contributed to TMA. Collaboration among various medical specialists was crucial in the successful management and treatment of this complex case.

Keywords

thrombotic microangiopathy

acute sarcoidosis

hypercalcemia

pancreatitis

microangiopathic hemolytic anemia

multisystem involvement

corticosteroids

granulomatous inflammation

multidisciplinary management

case study