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Case Reports: Reminder of important clinical lesson
Dyspnoea in a patient with biopsy-proven pulmonary sarcoidosis: the challenges in diagnosing cardiac sarcoidosis
  1. Amanda Yin-Chieh Chen1,
  2. Sheliza Halani1 and
  3. Rupal Shah1,2
  1. 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2General Internal Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Sheliza Halani; sheliza.halani{at}mail.utoronto.ca

Abstract

A man in his 60s with biopsy-proven pulmonary sarcoidosis, not on treatment, presented with 6 weeks of dyspnea to the emergency department. ECG showed first-degree atrioventricular block and CT thorax demonstrated progressive pulmonary sarcoidosis with new multifocal consolidation. Antibiotics were initiated.

A brain natriuretic peptide was elevated at 2024 ng/L and echocardiogram showed global left ventricular systolic dysfunction. Coronary angiogram revealed normal coronary arteries, and cardiac positron emission tomography and MRI demonstrated patterns compatible with cardiac sarcoidosis. The patient significantly improved with diuresis; he was started on prednisone, methotrexate and standard heart failure therapies.

We outline the difficulties of attributing cardiac causes of dyspnoea in a patient with known pulmonary sarcoidosis given the rarity of cardiac involvement. We review proposed diagnostic criteria for cardiac sarcoidosis using enhanced imaging techniques without requiring invasive myocardial biopsy. This case discussion also highlights nuances in managing cardiac sarcoidosis based on the best available evidence and expert consensus.

  • Heart failure
  • Cardiovascular medicine
  • Arrhythmias

http://dx.doi.org/10.1136/bcr-2022-252737

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    Footnotes

    • AY-CC and SH are joint first authors.

    • AY-CC and SH contributed equally.

    • Contributors All authors contributed equally to the preparation of this manuscript. SH and AY-CC are co-first authors on this manuscript and prepared this manuscript together with and under the supervision of RS.

    • 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.