Abstract 15412: Unusual Case of Cardiac Sarcoidosis Unmasked by COVID 19

Abstract

Background: COVID-19 can present with a constellation of symptoms and cardiac dysfunctions. It can mimic cardiac sarcoidosis clinically which can lead to diagnostic challenges and treatment delays. We describe a case of cardiac sarcoidosis which was unmasked by a recent COVID-19 infection. Case: A 72-year-old Caucasian male with history of post-traumatic epilepsy as a child and otherwise no significant health issues until March 2022 when he had COVID-19 infection presented with worsening fatigue, dizziness, lightheadedness, abnormal eye movements, brain fog and inability to exercise since his COVID infection. Prior to this, he was very active and was riding his bike 50 miles a week. He underwent extensive neurological work up including CT head/neck/temporal bone, MRI brain and continuous EEG that was unrevealing. Echocardiogram showed normal left and right ventricular size and function with no significant valvular abnormalities. 2-week Holter monitor revealed bradycardia with HR 30 beats per minute and sinus pauses with longest of 3.9 seconds. Cardiac MRI was obtained which showed late gadolinium enhancement (LGE) in the basal septum (Image). Subsequent, PET scan revealed mid myocardial FDG uptake with preserved perfusion involving the proximal segments of the heart raising the possibility of early inflammation related to cardiac sarcoidosis or other inflammatory process. He underwent dual chamber pacemaker implantation for sinus pauses. Decision making: Cardiac MRI with LGE in basal septum and PET scan showing increased FDG uptake along with bradycardia and pauses leading to pacemaker implantation led to the diagnosis of cardiac sarcoidosis. He was treated with prednisone with repeat PET scan in 3 months. Conclusion: It remains unclear if COVID 19 plays a role in inducing inflammatory process of sarcoidosis. Further studies are required to understand the cardiac sequalae of COVID 19 infection and association with sarcoidosis.