Cardiac sarcoidosis: a case report

R H A I Rathnaweera

doi:10.4038/mljsl.v8i1.7406

Abstract

Sarcoidosis is a granulomatous disease of unknown etiology, which can affect people of all racial and ethnic groups and can occur at all ages. Currently, sarcoidosis is considered as a worldwide disease with different prevalence rates. Arrhythmias are the leading cause of sudden death among patients diagnosed with cardiac sarcoidosis. In this case, the deceased was a 51-year-old male, a foreigner, with a history of type II diabetes and hypertension and was on treatment for 12 years. He was found unresponsive in a chair at his residence by his son. Autopsy revealed an enlarged heart (heart weight 543 g, 95th percentile for height is 387 g; 95th percentile for weight is 474 g). The pericardial sac is intact. There are no adhesions and no collections of fluid or blood. Epicardium was unremarkable. No acute ischaemic changes were seen in the myocardium. The coronary arteries were normal in configuration with a right dominant circulation. Histopathology of all organs were performed. Sections of myocardium showed varying degrees of replacement fibrosis with an inflammatory infiltrate comprising epithelioid histiocytes, giant cells and occasional non-necrotizing granulomata. There were no acute ischaemic changes. Toxicology screening was negative for common poisons and substance of abuse. These findings were in keeping with cardiac sarcoidosis and concluded it as cause of death. This was a rare case of sarcoidosis where the diagnosis was made with the aid of thorough histopathology examination. The importance of a thorough knowledge on specific cardiac conditions that can cause sudden death is highlighted here.

Highlights

Sarcoidosis is a granulomatous disease of unknown etiology, which can affect people of all racial and ethnic groups and can occur at all ages.[1]
Sarcoidosis is considered as a worldwide disease with different prevalence rates
Autopsy studies have estimated the prevalence of cardiac involvement in at least 25% of patients with sarcoidosis in the United States where as it is as high as 58% in Japanese population.[6]

Summary

Introduction

Sarcoidosis is a granulomatous disease of unknown etiology, which can affect people of all racial and ethnic groups and can occur at all ages.[1]. The lungs are the commonly affected organ Other organs such as heart, liver, spleen, skin, eye, parotid gland or any other organ or tissue can get affected with this condition.[1] It is estimated that in approximately 5% of the patients diagnosed with sarcoidosis, clinically identifiable cardiac involvement can be seen.[1] Autopsy studies have estimated the prevalence of cardiac involvement in at least 25% of patients with sarcoidosis in the United States where as it is as high as 58% in Japanese population.[6] When there is cardiac involvement, the prognosis is not favourable. The right ventricular wall thickness was 5 mm and the left ventricular free wall thickness was 20 mm. Sections of myocardium showed varying degrees of replacement fibrosis with an inflammatory infiltrate comprising epithelioid histiocytes, giant cells and occasional non-necrotizing granulomata (Figure 1, Figure 2, Figure 3)

Discussion

Findings

Conclusions