Isolated Cardiac Sarcoidosis Masquerading as Peripheral Vertigo: A Case Report

Cardiac sarcoidosis is a rare cause of cardiomyopathy and is especially difficult to diagnose when there is no pulmonary involvement in the patient. Here, we present a case of a 70-year-old male nil premorbid patient who presented with complaints of giddiness and fatigue. The episodes of giddiness were characterized as a feeling of intense sensation of imbalance as if he was falling forward, which was initially diagnosed as peripheral vertigo after thorough evaluation. The cardiac causes were initially ruled out as he had no symptoms of chest pain, dyspnea, or palpitations; his cardiac physical examination was completely normal, and echocardiography showed normal biventricular systolic function with no wall motion abnormalities. With time, new symptoms appeared, such as chest pain and fatigue, which made the patient present to the Emergency Medicine Department (EMD), where the cardiac echocardiography revealed a possible scar, and a cardiac MRI, which was done post-echo, showed continuous epicardial late gadolinium enhancement along the lateral, inferior, and anterior walls of the mid and basal cavities of the left ventricle. An FDG PET-CT (Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography) scan showed diffuse hypermetabolism of the left ventricle, which narrowed the diagnosis to cardiac sarcoidosis. After the implantable cardioverter defibrillator (ICD) insertion alongside corticosteroids and antiarrhythmics, the patient had a dramatic improvement in symptoms. This case highlights the importance of timely and repeated cardiac evaluations and the use of advanced imaging techniques in patients with unexplained presyncope associated with conduction abnormalities.