Left ventricular aneurysm and ventricular tachycardia as initial presentation of cardiac sarcoidosis

Cardiac sarcoidosis (CS) is a rare, potentially fatal disease. It has a wide range of clinical presentations that range from asymptomatic electrocardiogram changes to sudden cardiac death. Ventricular aneurysms and ventricular tachycardia are seen late in the disease, and are rarely the presenting manifestation of the disease. Diagnosis of CS is challenging and often missed or delayed.

We report a 35-year-old patient who presented with sustained ventricular tachycardia and ST-elevation on electrocardiogram. Cardiac catheterization showed normal coronaries and left ventricular aneurysm. Subsequent 2D-echocardiography showed an infiltrative disease pattern. Cardiac MRI was done and showed late gadolinium enhancement in the septum, apex and lateral wall. The patient was diagnosed with cardiac sarcoidosis and treated with immune suppression and antiarrhythmic agent. In addition underwent AICD implantation.

Our case highlights the importance of suspecting cardiac sarcoidosis in young patients presenting with electrocardiogram changes, and present an atypical presentation of this disease.