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Great mimicker: definite isolated cardiac sarcoidosis masquerading as hypertrophic cardiomyopathy
  1. Tuan Pham1,
  2. Jacob Abraham2 and
  3. Farooq H Sheikh3
  1. 1Department of Medicine, Adventist Health Portland, Portland, Oregon, USA
  2. 2Heart and Vascular Institute, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA
  3. 3MedStart Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
  1. Correspondence to Dr Tuan Pham; phamtuan.pub{at}gmail.com

Abstract

A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy.

  • Cardiovascular medicine
  • Arrhythmias
  • Pacing and electrophysiology

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: TP was responsible for writing and drafting the manuscript, including the creation and drafting of figures and tables. JA and FHS were responsible for reviewing, guiding and editing the final manuscript. The following authors gave final approval of the manuscript: TP, JA and FHS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.