Sarcoidosis is a multisystem inflammatory disorder and can affect any organ; however, ureteric\ninvolvement is extremely rare with only four cases reported in the literature to date, all of which were diagnosed\nwith surgical ureteral resection including a nephroureterectomy. This study reports the first case of ureteric\nsarcoidosis controlled with medical therapy where a differential diagnosis was performed based on the diagnostic\nclue of hypercalcemia. A definitive diagnosis was established without surgical resection of the ureter.\nCase presentation: A 60-year-old man presented with anorexia and weight loss. Blood tests showed renal\ndysfunction and hypercalcemia. Computed tomography revealed left hydronephrosis associated with left lower\nureteral wall thickening, which showed high signal intensity on diffusion-weighted magnetic resonance imaging.\nSimilarly, we detected a bladder tumor on cystoscopy, and a 2-cm-long stenosis was revealed by retrograde\nureterography; therefore, ureteral cancer was suspected. Meanwhile, considering the clinical implication of\nhypercalcemia, a differential diagnosis of sarcoidosis was established based on elevated levels of sarcoidosis\nmarkers. Fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the left\nlower ureter, skin, and muscles, suggestive of ureteric sarcoidosis with systemic sarcoid nodules. For a definitive\ndiagnosis, transurethral resection of the bladder tumor and ureteroscopic biopsy were performed. Histopathological\nexamination revealed ureteric sarcoidosis with bladder urothelial carcinoma. Following an oral administration of\nprednisolone, hypercalcemia instantly resolved, the renal function immediately improved, and the left ureteral\nlesion showed complete resolution with no recurrence.\nConclusions: In this case, the co-occurrence of ureteral lesion with bladder tumor evoked a diagnosis of ureteral\ncancer. However, considering a case of ureteral lesion complicated with hypercalcemia, assessment for differential\ndiagnosis was performed based on the calcium metabolism and sarcoidosis markers. In cases of suspected ureteric\nsarcoidosis from the assessment, pathological evaluation with ureteroscopic biopsy should be performed to avoid\nnephroureterectomy.
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