Introduction: Sarcoidosis is described as a systemic condition characterized by non-caseating granulomas in multiple organs. In this report, we present an unusual manifestation of cardiac sarcoidosis and review management strategies.
Case presentation: A 29-year-old African-American man presented with weight loss, fatigue, dyspnea, palpitations, night sweats, painless left eye redness and bilateral leg pain over the course of three months. His physical exam revealed left conjunctival congestion and bilateral crackles on auscultation. Computerized tomography of the chest showed severe parenchymal disease with bilateral fibrotic bands. Bronchoscopy and transbronchial biopsy revealed noncaseating granulomas and multinucleated giant cells, confirming sarcoidosis. Non-sustained ventricular tachycardia developed. Cardiac MRI showed myocardial delayed gadolinium enhancement. He responded to methotrexate and steroid therapy. An implantable cardioverter-defibrillator was placed.
Discussion: Although cardiac sarcoidosis manifests in only 5% of sarcoidosis, autopsy reports indicate subclinical cardiac involvement in up to 30%. There are no established criteria for diagnosis of cardiac sarcoidosis.
Conclusion: Early recognition and diagnosis of cardiac sarcoidosis is challenging but vital due to unpredictability and high risk for malignant cardiac involvement. Newer diagnostic imaging modalities have further aided in earlier identification and prevention of sudden cardiac death.
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Details
Title
Palpitations as a presenting feature of multisystem sarcoidosis
Creators
Richie Manikat - Easton Hospital
Julieta Gilson - Easton Hospital
Mahesh Krishnamurthy - Easton Hospital
Koroush Khalighi - Easton Hospital
Publication Details
Journal of community hospital internal medicine perspectives, v 7(3), pp 190-193
Publisher
Taylor & Francis
Resource Type
Journal article
Language
English
Academic Unit
Medicine (Graduate)
Web of Science ID
WOS:000405898000011
Other Identifier
991019168482804721
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