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Not Another ACS Rule Out.

S Preston1, R Nelson1, M Watts1

  • 1Tulane University School of Medicine, Department of Internal Medicine in New Orleans, LA.

The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society
|April 18, 2017
PubMed
Summary
This summary is machine-generated.

This case report details multi-organ Sarcoidosis presenting as acute coronary syndrome (ACS). It highlights Sarcoidosis as a rare cause of chest pain, emphasizing its varied presentation and the need for broad differential diagnosis.

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Area of Science:

  • Internal Medicine
  • Cardiology
  • Neurology
  • Pulmonology

Background:

  • Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
  • Cardiac and neurologic involvement in Sarcoidosis are uncommon, and rarely present as acute coronary syndrome (ACS).
  • Patients with cardiovascular risk factors may obscure the diagnosis of Sarcoidosis presenting with chest pain.

Purpose of the Study:

  • To report a rare case of multi-organ Sarcoidosis presenting simultaneously with neurologic, pharyngeal, pulmonary, and cardiac manifestations.
  • To emphasize the importance of considering Sarcoidosis in the differential diagnosis of recurrent chest pain of unclear etiology, even in the presence of traditional cardiovascular risk factors.

Main Methods:

  • A case study of a 50-year-old woman with a history of diabetes, hypertension, and hyperlipidemia presenting with worsening chest pain.
  • Diagnostic workup included EKG, echocardiography, cardiac MRI, modified barium swallow, brain MRI, chest CT, and endobronchial biopsy.
  • Treatment involved high-dose corticosteroids.

Main Results:

  • The patient presented with symptoms mimicking acute coronary syndrome (ACS), including chest pain, dysarthria, and Bell's Palsy.
  • Diagnostic imaging and biopsy confirmed multi-organ Sarcoidosis affecting the heart, brain, pharynx, and lungs.
  • Corticosteroid therapy led to rapid clinical improvement, including resolution of swallowing difficulties, cardiac function recovery, and neurologic deficits.

Conclusions:

  • This is the third reported case of multi-organ Sarcoidosis presenting as ACS, highlighting its rare but significant cardiac manifestation.
  • The case underscores that Sarcoidosis can mimic coronary artery disease, necessitating its inclusion in the differential diagnosis for atypical presentations of chest pain.
  • Early diagnosis and treatment with corticosteroids can lead to significant recovery of organ function in patients with Sarcoidosis.