Old tiger man: a case of sarcoid myopathy.

Fonseca JF, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220177 Description A 76-year-old man presented with asthenia and proximal muscle weakness during the past 6 months. A general physical examination proved to be unremarkable. Blood tests showed hypercalcaemia (ionised calcium 1.52 mmol/L) and normal creatine phosphokinase (CPK). Additional studies findings included: suppressed parathyroid hormone level (<2.5 pg/mL), low 1,25(OH)2vitamin D (14 ng/mL) and elevated serum angiotensin-converting enzyme (107 IU/L). Cell blood count, renal function, C reactive protein, erythrocyte sedimentation rate and urinary calcium were normal. A fluorodeoxyglucose positron emission tomography (FDG-PET) scan was ordered demonstrating enlarged hilar, mediastinal and right supraclavicular lymph nodes (figure 1A) and diffuse linear abnormal hypercaptation of the musculature (figures 1B and 2). Although the electromyogram (EMG) has not shown changes, a biopsy of the gastrocnemius muscle presented well-defined non-necrotising granulomas, suggesting sarcoid myopathy. Exclusion of other granulomatous diseases enabled the definitive diagnosis. The patient was successfully treated with prednisolone.