English

Abstract

Sarcoidosis is an uncommon disease in India and Cardiac Sarcoidosis is a known but uncommon manifestation of Sarcoidosis. The clinical features and presentations of cardiac sarcoidosis are protean and vary from benign ectopic to life threatening ventricular tachycardia. The outcome of most of the cases that are not diagnosed in time is sudden death. (1) much higher than the number of cases reported. This could be due to the lack of awareness of the disease with increased chances of misdiagnosis clinically. The incidence of sarcoidosis in developing countries like India has been underestimated, due to overwhelming incidence of tuberculosis which mimics this condition closely. Most of the affected patients are young adults and survival is limited to 2-3 years after cardiac involvement. The diagnosis based on clinical features is really difficult because of its varied presentation, ranging from benign arrhythmias to fatal ventricular fibrillations. (3) Therefore one has to be very careful while dealing with cases suspected to have any cardiac symptom .The same holds good even for cases with abnormal cardiac or pulmonary investigations. CASE REPORT: We describe a case of myocardial involvement by sarcoidosis that lead to sudden death of a 38 years old man. He was found dead and autopsy was conducted to know the cause of death. Viscera were sent for histopathological examination. Grossly there was hypertrophy of heart (figure1).Cut surface of heart showed grey white patchy areas over the interventricular septum and extending towards right and left ventricular wall (figure2).Multiple sections were processed from the affected area. Microscopy revealed the presence of non caseating granulomas with numerous giant cells in the background (figure3).Gross appearance of lungs was unremarkable. The microscopy showed non caseating granulomas with giant cells in the lungs too (figure4). The autopsy report was finalised as cardiac sarcoidosis to be the cause of sudden death after ruling out other causes of granulomatous lesions affecting the heart. Since it was a post-mortem case, investigation reports were not available.