Which laboratory finding is commonly associated with sarcoidosis?

• A. Decreased ESR
• B. Normal ACE
• C. Hypercalcemia
• D. Leukopenia

Answer: (C)

In sarcoidosis, granulomas contain activated macrophages that express 1-alpha hydroxylase, which converts vitamin D into its active form outside the kidney. This leads to increased intestinal absorption of calcium, often producing hypercalcemia. This vitamin D–mediated mechanism makes hypercalcemia a classic lab finding in sarcoidosis, more characteristic than the other options.

ESR is typically elevated in inflammatory conditions, so decreased ESR is unlikely. ACE levels can be elevated due to granuloma burden but aren’t guaranteed to be high in every patient, so a normal ACE doesn’t rule it out. Leukopenia is not a typical feature of sarcoidosis.