The conundrum of cardiac sarcoidosis

Abstract

Introduction: Sarcoidosis can be a benign, incidentally discovered condition or a life-threatening disorder causing sudden death. The frequency of myocardial involvement is unclear; small registries suggest 5 percent of patients with systemic sarcoidosis, while autopsy studies suggest subclinical cardiac involvement in up to 70 percent. The range of sarcoid involvement of the heart includes heart block and arrhythmias, heart failure, valvular dysfunction, simulated infarction, and pericardial disease. Case Description: 37 year-old African American female with past medical history of presumed asthma presented to the emergency room complaining of progressively worsening dyspnea, chest pain and lightheadedness. Physical examination showed tachycardia with displaced point of maximal impulse (PMI) and minimal rhonchi on right lung base. Laboratory workup did not show any significant results on presentation. Chest X-ray showed bilateral interstitial infiltrates and the chest Computed Tomography (CT) Angiogram showed bilateral scattered pulmonary nodules, right-sided pleural effusion with thickening. Lung biopsy showed non-caseating granulomas typical of sarcoidosis. Further workup revealed Ejection Fraction (EF) of 25% on Transthoracic Echocardiogram (TTE), cardiac catheterization showed normal coronaries and electrophysiological study for inducible arrhythmias was negative. Conclusion: Cardiac sarcoidosis may be suddenly fatal. Therefore, clinicians must maintain a high degree of suspicion for cardiac involvement and screen all patients with extra cardiac sarcoidosis. Despite significant advances in immunosuppressant pharmacotherapy, the backbone of therapy for cardiac sarcoidosis remains systemic corticosteroids.