Abstract
Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentation. CS has been linked to a significant high morbidity & mortality. We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis. A second patient, who was diagnosed initially with pulmonary Sarcoidosis, presented with a severe heart conduction abnormality. Both patients were successfully treated with permanent pacemakers. The dual purpose of our study is first to emphasize the importance of follow up on patients with Non-Cardiac Sarcoidosis for cardiac involvement and secondly to increase awareness of CS as part of a differential diagnosis among young adults with unexplained arrhythmia.
Highlights
We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis
Gallium (68Ga) PET scan indicated multiple foci of increased uptake on mediastinum and axillae, highly suspicious to Sarcoidosis with Cardiac Involvement (Figure 3—Gallium PET scan showed multiple foci of increased uptake on mediastinum and axillae).The Final diagnosis of Sarcoidosis was established by mediastinal lymph node biopsy showing non-caseating epithelioid cell granulomas of sarcoidosis (Figure 4—Mediastinal Lymph node biopsy indicate noncaseating epithelioid cell granulomas of sarcoidosis (H & E staining))
A 58-year-old female who was recently diagnosed with pulmonary Sarcoidosis based on chest CT finding indicated bihilar and mediastinal lymph nodes enlargement (Figure 5—CT scan of the chest showing bihilar and mediastinal lymph nodes enlargement) and high level of serum Angiotensin converting enzyme (ACE)
Summary
Sarcoidosis is a rare, multisystem, granulomatous disease of unknown etiology that most often affects the lungs (over 90%), skin, eyes, and lymphoreticular system [1] [2]. The disease manifests itself worldwide, without regard to gender, age and ethnicity [4] [5] [6] [7] It usually develops before the age of 50, the incidence rate displays a biphasic pattern with the first peak between the ages of 25 - 39 and the second between the ages of 60 - 64 [8] [9]. CS manifestations include conduction disorders, arrhythmias, Atrial and Ventricular arrhythmias, congestive heart failure, valvular pathology, pericardial effusions and sudden cardiac death [11] [12]. Screening for cardiac involvement in patients with known Sarcoidosisin other organ systems is crucial, especially because sudden death may be the first manifestation of CS and prompt treatment can reduce its risk [16]. Screening for cardiac involvement in specific clinical presentations in patients without known Sarcoidosis, can identify CS patients early in their disease course. A clinical diagnosis of CS is critically important in the planning of therapeutic strategy
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