Sarcoidosis, 1 Case Report, 3 Rare Associations

Abstract

The authors present the case of a 78-year-old woman who was
admitted with a 3-month history of weakness, dorsalgy, xerostomia
and bilateral parotid swelling. Laboratory evaluation showed
hyponatremia(127 mmol/L) and D-dimer elevation (3x normal). A
contrast enhanced computed tomography revealed multiple hilaradenopathy
and intraluminal aortic thrombosis. Fine needle aspiration
cytology of parotid gland and mediastinic lymph node biopsy
showed granulomatous lesions compatible with sarcoidosis. The
diagnosis of syndrome of inappropriate antidiuretic hormone secretion
was supported by a serum and urine osmolality of 251 mosm/
L and 264 mosm/L respectively, associated with a natriuresis
of 119 mmol/24h. A cranial magnetic resonance image revealed
no pituitary involvement. Systemic corticotherapy was initiated with
symptoms relief and a significant volume reduction of the parotid
glands. This case report describes a rare association of an atypical
presentation, an unusual neuroendocrine manifestation and aortic
intraluminal thrombosis, a rare phenomenon whose pathogenesis
is not fully clarified.