A Case of Isolated Bone Marrow Sarcoidosis Presenting as Symptomatic Hypercalcemia.

Sarcoidosis is primarily a disease of the lungs, and extrapulmonary manifestations are rare. Herein we report a case of isolated bone marrow sarcoidosis presenting as symptomatic hypercalcemia. A 75-year-old female presented with complaints of confusion, dizziness, headaches, and tremulousness. Workup was unremarkable save for hypercalcemia and elevated serum 1,25(OH)D3. Bone marrow biopsy revealed non-caseating granulomas suggestive of sarcoidosis. She was treated with a slow prednisone taper and her symptoms resolved. This case demonstrates the diagnostic and therapeutic challenges associated with a novel presentation and endorses the use of bone marrow biopsy in the workup of sarcoidosis. The risks and benefits of calcium and vitamin D supplementation for steroid-induced bone disease prevention in this population are also discussed.