Combination therapy with corticosteroid and mycophenolate mofetil in a case of refractory cardiac sarcoidosis

Abstract

Management of cardiac sarcoidosis (CS) can be challenging. The first-line therapy for this condition is corticosteroids, but other immunosuppressive agents are sometimes co-administered to reduce the dosage of corticosteroid and to thereby avoid steroid-induced adverse effects or to increase its therapeutic efficacy. Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid, an inhibitor of inosine monophosphate dehydrogenase that acts more selectively on T and B lymphocytes when compared with azathioprine. A 40-year-old man was diagnosed with CS after presenting with ventricular fibrillation. His left ventricular ejection fraction was severely reduced (30%), and cardiac positron emission tomography (PET) showed abnormal uptake of 18F-fluorodeoxyglucose. A cardioverter-defibrillator was implanted and prednisolone (30mg/day) was administered. He was re-admitted with recurrent sustained ventricular tachycardia and a positive PET finding despite a 5-month course of prednisolone, and MMF (1000mg/day) was administered. Six months later, he had not required re-hospitalization for heart failure or arrhythmia. We conclude that combination therapy with MMF and corticosteroids is useful for refractory CS.<Learning objective: Management of cardiac sarcoidosis (CS) can be challenging. Although some immunosuppressive agents are co-administered to reduce the dosage of corticosteroids or to intensify the effect of corticosteroids, the optimal combination regimen has not yet been established. This case report shows that combination therapy with corticosteroid and mycophenolate mofetil was useful for CS that was refractory to corticosteroid monotherapy.>