P1-5 - A Case of Cardiac Sarcoidosis With Difficulty of Steroid Therapy Due to Coexistence of Pulmonary Aspergillosis

Abstract

A 76-year-old woman was admitted to our hospital with the chief complaint of dyspnea. Chest radiograph showed pulmonary congestion, and echocardiography revealed a decrease in LVEF of 47% with thinning of the basal interventricular septum. She was suspected to have cardiac sarcoidosis, and she was hospitalized to undergo detailed examinations. There were no coronary artery lesions with cardiac catheterization, and no abnormal findings in myocardial biopsy of the right ventricle. Gallium scintigraphy showed no abnormal uptake. Chest CT showed multiple granular shadows in bilateral lungs, and aspergilloma in the upper left lobe. Anti-fungal drug did not improve aspergillosis, and she had blood sputum. Left upper lobectomy was performed for this treatment. As the pathological findings revealed that she had two difficult lesion in the lung, aspergilloma and sarcoidosis. According to these findings, the heart lesion was diagnosed as cardiac sarcoidosis. In this case, because it was considered that introduction of steroid could result in relapse of pulmonary aspergillosis, she has not received steroid therapy. We report a case of cardiac sarcoidosis with difficulty to administer steroid therapy due to coexistence of pulmonary aspergillosis including literature considerations.