Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentation. CS has been linked to a significant high morbidity & mortality. We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis. A second patient, who was diagnosed initially with pulmonary Sarcoidosis, presented with a severe heart conduction abnormality. Both patients were successfully treated with permanent pacemakers. The dual purpose of our study is first to emphasize the importance of follow up on patients with Non-Cardiac Sarcoidosis for cardiac involvement and secondly to increase awareness of CS as part of a differential diagnosis among young adults with unexplained arrhythmia.
References
[1]
Newman, L.S., Rose, C.S. and Maier, L.A. (1997) Sarcoidosis. The New England Journal of Medicine, 336, 1224-1234.
https://doi.org/10.1056/NEJM199704243361706
[2]
Fauci, A., Kasper, D., Hauser, S., Jameson, J. and Loscalzo, J. (2011) Harrison’s Principles of Internal Medicine. 18 Edition, McGraw-Hill Professional, New York.
[3]
Matsui, Y., Iwai, K., Tachibana, T., et al. (1976) Clinicopathological Study on Fatal Myocardial Sarcoidosis. Annals of the New York Academy of Sciences, 278, 455-469. https://doi.org/10.1111/j.1749-6632.1976.tb47058.x
[4]
Morimoto, T., Azuma, A., Abe, S., Usuki, J., Kudoh, S., Sugisaki, K., Oritsu, M. and Nukiwa, T. (2008) Epidemiology of Sarcoidosis in Japan. European Respiratory Journal, 31, 372. https://doi.org/10.1183/09031936.00075307
[5]
Rybicki, B.A., Major, M., Popovich Jr., J., Maliarik, M.J. and Iannuzzi, M.C. (1997) Racial Differences in Sarcoidosis Incidence: A 5-Year Study in a Health Maintenance Organization. American Journal of Epidemiology, 145, 234-241.
https://doi.org/10.1093/oxfordjournals.aje.a009096
[6]
Siltzbach, L.E., James, D.G., Neville, E., et al. (1974) Course and Prognosis of Sarcoidosis around the World. American Journal of Medicine, 57, 847-852.
https://doi.org/10.1016/0002-9343(74)90160-0
[7]
Milman, N. and Selroos, O. (1990) Pulmonary Sarcoidosis in the Nordic Countries 1950-1982: Epidemiology and Clinical Picture. Sarcoidosis, 7, 50-57.
[8]
Sekhri, V., Sanal, S., DeLorenzo, L.J., Aronow, W.S. and Maguire, G.P. (2011) Cardiac Sarcoidosis: A Comprehensive Review. Archives of Medical Science, 7, 546-554. https://doi.org/10.5114/aoms.2011.24118
[9]
Baughman, R.P., Teirstein, A.S., Judson, M.A., Rossman, M.D., Yeager, H., Bresnitz, E.A., DePalo, L., Hunninghake, G., Iannuzzi, M.C., Johns, C.J., McLennan, G., Moller, D.R., Newman, L.S., Rabin, D.L., Rose, C., Rybicki, B., Weinberger, S.E., Terrin, M.L., Knatterud, G.L. and Cherniak, R. (2001) Clinical Characteristics of Patients in a Case Control Study of Sarcoidosis. American Journal of Respiratory and Critical Care Medicine, 164, 1885-1889. https://doi.org/10.1164/ajrccm.164.10.2104046
[10]
Pietinalho, A., Hiraga, Y., Hosoda, Y., Lofroos, A.B., Yamaguchi, M. and Selroos, O. (1995) The Frequency of Sarcoidosis in Finland and Hokkaido, Japan: A Comparative Epidemiological Study. Sarcoidosis, 12, 61-67.
[11]
Habersberger, J., Manins, V. and Taylor, A.J. (2008) Cardiac Sarcoidosis. Internal Medicine Journal, 38, 270-277. https://doi.org/10.1111/j.1445-5994.2007.01590.x
[12]
Sharma, O.P. (2003) Diagnosis of Cardiac Sarcoidosis an Imperfect Science, a Hesitant Art. Chest, 123, 18-19. https://doi.org/10.1378/chest.123.1.18
[13]
Burstow, D.J., Tajik, A.J., Bailey, K.R., DeRemee, R.A. and Taliercio, C.P. (1989) Two-Dimensional Echocardiographic Findings in Systemic Sarcoidosis. American Journal of Cardiology, 63, 478-482. https://doi.org/10.1016/0002-9149(89)90323-8
[14]
Dubrey, S.W., Bell, A. and Mittal, T.K. (2007) Sarcoid Heart Disease. Postgraduate Medical Journal, 83, 618-623. https://doi.org/10.1136/pgmj.2007.060608
[15]
Tachibana, T., Iwai, K. and Takemura, T. (1991) Study on the Cause of Death in Patients with Sarcoidosis in Japan [Abstract]. XII World Congress on Sarcoidosis, Kyoto, Japan, 8 September 1991.
[16]
Iannuzzi, M.C., Rybicki, B.A. and Teirstein, A.S. (2007) Sarcoidosis Medical Progress. The New England Journal of Medicine, 357, 2153-2165.
https://doi.org/10.1056/NEJMra071714
[17]
Mori, M., Hanon, S. and Rachko, M. (2007) Case Report: Cardiac Sarcoidosis Presenting with Ventricular Arrhythmias: Case Report and Review of the Literature. International Journal of Cardiology, 120, e21-e23.
https://doi.org/10.1016/j.ijcard.2007.04.036
[18]
Tadamura, E., Yamamuro, M. and Kubo, S., et al. (2005) Effectiveness of Delayed Enhanced MRI for Identification of Cardiac Sarcoidosis: Comparison with Radionuclide Imaging. AJR. American Journal of Roentgenology, 185, 110-115.
https://doi.org/10.2214/ajr.185.1.01850110
