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A 53-year-old Afro-Caribbean woman presented to casualty with a constellation of symptoms pointing to a diagnosis of hypercalcaemia. This was confirmed on laboratory investigation. Findings of a raised serum protein (108 g/l) and normal albumin (35 g/l), lead to an initial working diagnosis of multiple myeloma. However, later serum protein electrophoresis found a polyclonal gammopathy and further investigation lead to a diagnosis of sarcoidosis. The patient responded well to conventional treatment with oral prednisolone. A number of learning points have been highlighted including the pitfalls of pattern recognition in diagnosis and the various manifestations of systemic sarcoidosis. A brief review of the history and various manifestations of sarcoidosis including the pathophysiology of hypercalcaemia in sarcoidosis are presented as well as of polyclonal gammopathy.

Hypergammaglobulinemia, normal serum albumin and hypercalcaemia: a case of systemic sarcoidosis with initial diagnostic confusion