Sarcoidosis. His symptoms of polyuria and polydipsia result from decreased concentrating ability, which occurs secondary to any cause of hypercalcemia.
3)
The patient had a raised serum angiotensin-converting enzyme level at 225 U/L and biopsy of one of the enlarged inguinal lymph nodes revealed multiple non-caseating epithelioid cell granulomata (Fig. 1a and b).
Fig. 1
a Hematoxylin and eosin (H&E) stain of enlarged lymph node at low magnification (×10) showing replacement of the cortex and paracortex of the node by numerous non-caseating epithelioid cell (arrow) granulomata. The peripheral sinus is preserved. b H&E stain of smear made of the lymph node when fresh showing aggregates of histiocytes forming granulomata (black arrow) and scattered multinucleated giant cells (white arrow), some of Langhans cell type. The intervening cells are normal mature lymphocytes. There is no evidence of lymphoma
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4)
Initial saline hyperhydration with 0.9 % NaCl and diuresis with frusemide failed to significantly reduce the total serum and ionized calcium levels over 48 h. Commencement of steroid treatment (prednisolone 2 mg/kg/day) led to a progressive fall in calcium levels; normalizing after 11 days of treatment.
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