Abstract
Death from cardiac rather than pulmonary causes is common in patients with sarcoidosis in Japan. At the same time, asymptomatic myocardial infarction is more common in diabetics than non-diabetics. In addition to diabetes mellitus, high serum concentration of lipoprotein(a) has been shown to be an independent risk factor for coronary artery disease. Our report discusses the case of a 60-year-old diabetic man with skin sarcoid lesions and elevated lipoprotein(a) levels who developed asymptomatic myocardial infarction. He had skin eruptions in the lower part of the left ear over a 20 year period. A skin biopsy revealed multiple noncaseating granulomas in September 1987, when he was also found to have diabetes mellitus. However, his ECG was normal. Treatment with glibenclamide (5mg daily) resulted in good glycemic control. An ECG taken in February 1989 showed changes in the anterolateral wall typical of myocardial infarction.During this period, he displayed no signs or symptoms suggestive of acute myocardial infarction. His glycemic control was excellent, with a mean (±SE) HbA1C of 6.9±0.1% over 11 measurements. Serum levels of total and HDL cholesterol averaged 210±4mg/dl and 47.8±1.4mg/dl, respectively. Serum lipoprotein(a) concentrations, however, were extremely high (59.4±1.5mg/dl, n=4) when compared to a control group (15.7±1.7mg/dl, n=76). Coronary arteriograms revealed a complete obstruction of the left anterior descending artery. However, right ventricular endomyocardial biopsy demonstrated no lesions suggestive of sarcoidosis, and systemic gallium scintigrams showed abnormal accumulation in the left ear but not the mediastinum.
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