Heerfordt Syndrome Complicated by Bilateral Simultaneous Facial Palsy, PTH-Independent Hypercalcemia, and Bilateral Obstructive Acute Kidney Injury in the Absence of Thoracic Disease: A Case Report and Narrative Review.

Background and Clinical Significance: Heerfordt syndrome (uveoparotid fever) is an uncommon extrapulmonary expression of sarcoidosis defined by parotid enlargement, uveitis, low-grade fever, and facial nerve palsy. It is identified in fewer than 1% of patients with biopsy-confirmed sarcoidosis, and the co-occurrence of bilateral seventh-nerve palsy with calcitriol-driven obstructive kidney injury has been reported only sporadically. Recognizing this metabolic-renal phenotype is clinically important because it is readily reversible yet easily missed when the chest radiograph is normal. Case Presentation: A 30-year-old man presented with four months of progressive bilateral parotid swelling, sicca symptoms, and intermittent blurred vision, preceded by a self-limited episode of bilateral simultaneous peripheral facial weakness; renal colic developed one month before admission. Evaluation showed parathyroid-hormone-independent hypercalcemia (peak corrected calcium 13.1 mg/dL), a serum angiotensin-converting enzyme level above 100 U/L, and acute kidney injury (creatinine 2.1 mg/dL) caused by bilateral upper-ureteric calculi with hydronephrosis. Posterior uveitis was confirmed ophthalmologically. Chest radiography and high-resolution thoracic computed tomography were unremarkable, with no hilar lymphadenopathy. Parotid gland biopsy demonstrated non-caseating epithelioid granulomas. Bilateral ureteric stenting and oral prednisolone 40 mg daily produced rapid normalization of serum calcium, recovery of renal function, and regression of parotid enlargement. Conclusions: This report characterizes a phenotype that combines bilateral simultaneous facial-nerve involvement, calcitriol-mediated hypercalcemia, and obstructive nephrolithiasis without coexistent pulmonary disease. It argues for early consideration of sarcoidosis whenever hypercalcemia, parotid enlargement, and cranial neuropathy occur together, and reinforces the reversibility of sarcoidosis-related renal injury when corticosteroids are introduced promptly.