[Tiger man: diagnosis at a glance in F18-FDG-PET-CT for the evaluation of muscle weakness and hypercalcemia].

A 68-year-old patient presented with weakness, recurrent falls, unintentional weight loss, and confusion. Symptomatic hypercalcemia secondary to a Vitamin D intoxication was initially identified as cause. Over time, proximal myopathy, edema of the forearms, persistent hypercalcemia with elevated 1,25 Vitamin D and increased inflammatory markers developed. A PET-CT showed disseminated linear uptake in the skeletal muscles («tiger man sign»). After muscular biopsy the suspicion of muscular sarcoidosis was confirmed. High-dose steroid therapy resulted in rapid clinical improvement.