What does this research mean for the field?

Isolated primary cardiac sarcoidosis can present as acute heart failure mimicking acute myocarditis, with severe left ventricular dysfunction that is reversible following steroid therapy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2013Internal MedicineOpen Access

Isolated Primary Cardiac Sarcoidosis Presenting as Acute Heart Failure

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Why the study?

Does steroid therapy improve ejection fraction in a patient with isolated primary cardiac sarcoidosis presenting as acute heart failure?

Structured PICO

Does steroid therapy improve ejection fraction in a patient with isolated primary cardiac sarcoidosis presenting as acute heart failure?

Population

A 65-year-old man presenting with acute onset of dyspnea and persistent fever, diagnosed with isolated primary cardiac sarcoidosis presenting as acute heart failure mimicking acute myocarditis (n=1).

Intervention

Steroid therapy

Outcome

Improvement in left ventricular ejection fractionsurrogate

Steroid therapy led to significant recovery of left ventricular ejection fraction in a rare case of isolated primary cardiac sarcoidosis presenting as acute heart failure.

Implication

Supports steroid consideration in isolated cardiac sarcoidosis with heart failure; hypothesis-generating and requires prospective confirmation.

Abstract

A 65-year-old man was referred to our hospital due to an acute onset of dyspnea and persistent fever. Echocardiography revealed an ejection fraction (EF) of 25% with diffuse severe left ventricular (LV) dysfunction. 18F-fluorodeoxy glucose-positron emission tomography imaging showed significantly increased uptake by the LV and right ventricular walls, indicating active inflammation. The histologic findings of the endomyocardial biopsy specimens indicated the presence of epithelioid cell granuloma. The final diagnosis was thus cardiac sarcoidosis with acute inflammation. Five-months after the initiation of steroid therapy, echocardiography showed an EF of 50%. This is a rare case in which acute inflammation led to acute heart failure mimicking acute myocarditis.