Concomitant Neurosarcoidosis and Cardiac Sarcoidosis: A Peculiar Path to Diagnosis

BACKGROUND Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas. Although the disease most commonly affects the respiratory and lymphatic systems, extrapulmonary manifestations involving the brain and heart also occur. Neurosarcoidosis may cause dysfunction of the cranial nerves, meninges, peripheral nerves, or the pituitary system. Cardiac sarcoidosis may lead to arrhythmias, cardiomyopathy, or heart failure. These specific diagnoses can be challenging because they may masquerade as isolated pathologies. In this clinical vignette, we present a rare case of systemic sarcoidosis with concomitant neurological and cardiac involvement. CASE REPORT A woman in her late 50s with a history of bilateral anterior uveitis presented with stroke-like symptoms. Initial workup was negative for stroke, but imaging identified a prevascular mediastinal lymph node and moderate mitral regurgitation. Lumbar puncture results were consistent with neurosarcoidosis, and steroids initiation led to symptom improvement. The patient subsequently exhibited non-sustained ventricular tachycardia, and further investigation revealed findings consistent with cardiac sarcoidosis. An implantable cardioverter-defibrillator was placed. The patient continued steroids and immunosuppressive therapy with favorable results. CONCLUSIONS Diagnosis of systemic sarcoidosis can be difficult because of its variable presentation. This challenge is enhanced when uncommon organs such as the brain and heart are affected. Thorough evaluation is therefore essential when evaluating systemic diseases.