title: Sarcoidosis presenting with hypercalcaemia following withdrawal of long-term immunosuppression in renal transplantation.
abstract: Long-term immunosuppression, including corticosteroids, is a hallmark of renal transplantation. We describe a patient who had a failed transplant after 15 years, subsequent graft nephrectomy and withdrawal of his immunosuppression therapy including prednisolone. Within months of complete cessation of prednisolone, he developed hypercalcaemia and subsequent systemic symptoms including ocular, respiratory and dermatological. A skin biopsy demonstrated non-caseating granulomatous lesion and a diagnosis of sarcoidosis was confirmed. Re-commencement with prednisolone resulted in complete resolution of clinical and biochemical features of sarcoidosis. Sarcoidosis is unlikely to present in the immunosuppressed patient. This case highlights that unexplained hypercalcaemia at the time of withdrawal of immunosuppression, including corticosteroids, may be a feature of sarcoidosis.
authors.affiliation: Department of Renal Medicine , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle NE7 7DN , UK ; Institute of Genetic Medicine, Newcastle University , Central Parkway, Newcastle NE1 3BZ , UK.
authors.forename: Edwin K S
authors.initials: EK
authors.lastname: Wong
authors.affiliation: Department of Pathology , Newcastle upon Tyne Hospitals NHS Foundation Trust , Queen Victoria Road, Newcastle NE1 4LP , UK.
authors.forename: Akhtar
authors.initials: A
authors.lastname: Husain
authors.affiliation: Department of Renal Medicine , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle NE7 7DN , UK ; Institute of Genetic Medicine, Newcastle University , Central Parkway, Newcastle NE1 3BZ , UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Sayer