Fulminant Cardiac Sarcoidosis Successfully Treated With Aggressive Immunosuppressive Therapy

Area of Science:

• Cardiology
• Immunology
• Pathology

Background:

• Cardiac sarcoidosis typically presents with subacute symptoms, with fulminant cases requiring mechanical circulatory support being exceptionally rare.
• Differentiating cardiac sarcoidosis from giant cell myocarditis is challenging due to overlapping histopathological and clinical features.

Observation:

• A 55-year-old woman presented with acute heart failure, ventricular arrhythmias, and atrioventricular block, necessitating mechanical circulatory support including extracorporeal membrane oxygenation and Impella 5.0.
• Pathological examination revealed cardiac sarcoidosis with inflammatory cell infiltration, giant cells, fibrosis, and granulomas.

Findings:

• Despite the fulminant presentation, aggressive immunosuppressive therapy with corticosteroids and cyclosporine was initiated, considering the possibility of giant cell myocarditis.
• The patient demonstrated significant improvement in cardiac function, allowing for discontinuation of all mechanical circulatory support and inotropic agents.

Implications:

• Aggressive combination immunosuppressive therapy may offer a favorable outcome in fulminant cardiac sarcoidosis, even when indistinguishable from giant cell myocarditis initially.
• This case highlights the potential therapeutic benefits of early and intensive immunosuppression in severe cardiac inflammatory conditions.