Necrotising renal vasculitis associated with sarcoidosis in a patient with oesophageal cancer: A case report.

Abstract

Sarcoidosis is a multisystem disorder characterised by noncaseating granulomas, often involving the lungs and lymph nodes, but can affect nearly any organ. Renal involvement in sarcoidosis typically presents as hypercalcaemia or interstitial granulomatous nephritis. Renal vasculitis, however, is an exceedingly rare manifestation. We present a case of a 74-year-old Japanese male who was diagnosed with oesophageal cancer and underwent chemoradiotherapy. He presented with hypercalcaemia and renal dysfunction, and laboratory tests revealed elevated serum creatinine and hypercalcaemia. Fluorodeoxyglucose-positron emission tomography/computed tomography showed intense uptake in the gluteal and adductor muscles, with no recurrence of oesophageal cancer. A muscle biopsy confirmed non-necrotising granulomas. Despite correction of hypercalcaemia, proteinuria and renal dysfunction persisted, prompting a renal biopsy. The biopsy revealed pauci-immune vasculitis, with fibrin deposition and destruction of the vascular elastic lamina, without granulomas. The patient was treated with corticosteroids, which led to significant improvement in renal function and proteinuria. This case highlights the rare coexistence of sarcoidosis and renal vasculitis. Thus, even in the presence of mild urinary abnormalities, renal biopsy should be considered in the diagnostic approach to sarcoidosis patients with renal dysfunction.