Introduction
Sarcoidosis is a multisystemic disorder, rare among children, which is characterized and diagnosed by non-caseating granulomas in biopsy of involved organ.
Most pediatric cases involves the skin, joint and eyes and presents with a triad of rash, uveitis and arthritis. Other manifestations include the lungs, lymph nodes and renal involvement.
Renal involvement in childhood sarcoidosis is rare and is usually diagnosed relatively late. Most cases presents with hypercalcemia and hypercalciuria that may eventually develop Nephrocalcinosis.
Case Report
A 13-year-old boy was admitted after evaluation of weakness, loss of appetite and fatigue that revealed renal insufficiency.
Upon admission, his vital signs were normal, physical examination was normal apart from mild pallor, 1/6 systolic murmur and a purplish rash on left thigh and leg, and laboratory data demonstrated anemia (hemoglobin of 10.4 g/dl), renal insufficiency (BUN - 76 mg/dl, serum creatinine level - 1.81 mg/dl) and hypercalcemia (12.23 mg/dl).
Chest radiograph showed minimal, bilateral, infiltrates, with mild restrictive disturbance demonstrated on pulmonary functions study. Renal biopsy revealed non caseating granulomas – leading to the diagnosis of sarcoidosis.
Treatment included 12 weeks of steroids, which resulted in improved pulmonary functions, resolution of constitutional symptoms and vast improvement in renal function (Creatinin level - 1.01 mg/dl).
Conclusion
Childhood Sarcoidosis is a rare condition, usually presents with skin, ophthalmic and joint involvement as first manifestation. Renal involvement is rare and is discovered in most cases during evaluation.
This patient demonstrated a rare case of childhood sarcoidosis that presented with renal insufficiency and was diagnosed during renal evaluation.
