Syncope and Sarcoidosis: A Criss-Cross of Diagnoses

Syncope has a broad range of differential diagnoses. Sarcoidosis, a multisystem inflammatory disorder characterized by the formation of noncaseating granulomas, is a rare but important diagnosis to consider while evaluating patients presenting with presyncopal or syncopal symptoms. Although sarcoidosis is most commonly known to affect the lungs, it is estimated that at least 25% of patients with sarcoidosis have myocardial involvement, with only 5% of these patients showing clinical symptoms. Here, we present the rare case of a Caucasian male patient diagnosed with cardiac sarcoidosis after presenting to the hospital with presyncope. The patient had an internal cardioverter-defibrillator placed during hospitalization and was initiated on prednisone and methotrexate in the outpatient setting. He exhibited clinical and radiographical improvement in the six-month follow-up period after treatment was initiated.