Abstract Background Sarcoidosis is a multisystem granulomatous disorder with a predilection for the lungs. Cardiac sarcoidosis represents less than five per cent of sarcoidosis cases and is associated with significant morbidity and mortality. Simultaneous involvement of the lungs, heart, and bone marrow in systemic sarcoidosis is exceptionally rare, with only about 4 cases reported in the literature. We present one such rare case with concurrent pulmonary, cardiac, and bone marrow involvement. Case Presentation A 73-year-old female with past medical history of biopsy-proven stage I pulmonary sarcoidosis presented with chest pain, dyspnea on exertion and was admitted for acute hypoxic respiratory failure requiring 2 L/min oxygen. Labs were significant for pancytopenia. Computed Tomography (CT) scan of the chest was noted for new nodular infiltrates and ground glass opacities. An extensive infectious disease workup was negative. The Electrocardiogram (EKG) showed a paced rhythm. The echocardiogram was noted to have an ejection fraction of 50%. A cardiac Magnetic Resonance Imaging (MRI) scan was deferred due to the presence of an incompatible implanted cardiac device. Cardiac Positron Emission Tomography (PET) scan revealed abnormal myocardial uptake throughout the left ventricle with an SUV of 6.7, concerning for cardiac sarcoidosis. A bone marrow biopsy revealed non-caseating granulomas consistent with bone marrow sarcoidosis. Patient was initiated on prednisone and infliximab with a plan for slow taper of prednisone over 6 months. Discussion Sarcoidosis is a granulomatous disease with potential multiorgan involvement. Cardiac sarcoidosis is associated with a worse prognosis. Early diagnosis is crucial to prevent organ-specific complications related to the disease. Treatment typically begins with corticosteroids, with steroid-sparing agents such as methotrexate or azathioprine used for long-term disease control. Biologic therapies like infliximab are reserved for refractory or severe cases, including our case with multiorgan disease, cardiac sarcoidosis presenting with heart failure or arrhythmias, and bone marrow involvement associated with cytopenia. This abstract is funded by: NIL
Ranga et al. (Fri,) studied this question.