Sarcoid, amyloid, and acute myocardial failure

We report the case of a 58-year-old woman, with an 8-year history of pulmonary sarcoidosis, who died in acute myocardial failure after cardiac catheterization. Systemic amyloid, likely of the AL type, was found to involve her myocardial interstitium and intramyocardial coronary arteries, as well as her spleen, thyroid, kidneys, and bone marrow. Her acute myocardial failure was thought to be the result of focal myocardial infarcts secondary to amyloid vasculopathy and of superimposed chronic restrictive myocardial function caused by amyloid. Five previously reported cases of concurrent sarcoidosis and AA-type amyloid remind us that there is significant experimental data implicating the inflammatory process of sarcoidosis in the causation of AA-type amyloidosis. The concurrence of sarcoidosis and AL-type systemic amyloid seen in this patient was reported in the literature once before, and we think the concurrence was a coincidence.