Cardiac sarcoidosis diagnosed by multimodality imaging.

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Cardiac sarcoidosis is a rare granulomatous disease affecting the heart, often presenting with arrhythmias.
• Diagnosis can be challenging due to nonspecific symptoms and varied imaging findings.

Observation:

• A 66-year-old woman presented with frequent premature ventricular contractions (PVCs) and basal septal akinesis.
• Initial investigations including echocardiography and coronary angiography were inconclusive.

Findings:

• Cardiac magnetic resonance imaging revealed mid-wall enhancement.
• Positron emission tomography demonstrated a perfusion defect with increased 18-fluorodeoxyglucose uptake, supporting cardiac sarcoidosis.
• High-dose steroids provided initial symptom relief but were discontinued due to side effects, necessitating ICD implantation.

Implications:

• Multimodality imaging is essential for accurate diagnosis of cardiac sarcoidosis.
• Management requires a tailored approach, often involving immunosuppression and device therapy.
• This case underscores the importance of integrating various imaging modalities for complex cardiac conditions.