Acute Pericardial Effusion Revealing Cardiac Sarcoidosis: A Case Report

Sarcoidosis is a rare disease of unknown cause. Several pathophysiological hypotheses have been proposed, including possible infectious or environmental triggers, genetic exposures, and autoimmune responses. Cardiac sarcoidosis preferentially affects the myocardium. We report the case of a 58-year-old patient with a history of hypertension who presented with acute pericarditis with effusion. The patient underwent surgical pericardial drainage. Analysis of the pericardial fluid showed a hemorrhagic and exudative appearance, with a protein level of 52 g/L (reference ˂30 g/L) and hypercellularity, predominantly lymphocytes at 93% (reference ˂50%). Pericardial fluid culture was negative, and PCR did not detect Mycobacterium tuberculosis DNA. Pericardial biopsy revealed a giant cell granuloma without caseous necrosis. This report describes a rare presentation of sarcoidosis and highlights the importance of a thorough etiological workup, particularly pericardial biopsy, in the investigation of acute pericarditis.