What question did this study set out to answer?

This case aims to illustrate the challenges and diagnostic importance of identifying cardiac sarcoidosis, particularly in corticosteroid-refractory patients.

June 24, 2026Cardiology and Angiology An International JournalOpen Access

Reversible Severe Heart Failure in Corticosteroid-Refractory Cardiac Sarcoidosis: The Crucial Role of 18F-FDG PET/CT in MRI-Negative Disease

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Key result

18F-FDG PET/CT identifies MRI-negative cardiac sarcoidosis, guiding early therapy that improves LVEF to 52%.

Key Points

This case aims to illustrate the challenges and diagnostic importance of identifying cardiac sarcoidosis, particularly in corticosteroid-refractory patients.
Case presentation of a 43-year-old female with heart failure and a history of cutaneous sarcoidosis.
Used 18F-FDG PET/CT for diagnosis after non-contributory cardiac magnetic resonance imaging.
Treatment involved intravenous corticosteroids, methotrexate, and optimized guideline-directed medical therapy.
Initial ejection fraction was 26%, which improved to 52% after treatment at one-year follow-up.
The 18F-FDG PET/CT indicated active granulomatous inflammation despite normal findings in CMR imaging.
Demonstrating that early intervention can result in complete normalization of heart function in severe cases.

Structured PICO

Population

1 patient (n=1), 43-year-old female with a history of cutaneous sarcoidosis on chronic oral corticosteroids presenting with rapidly progressive heart failure (NYHA class III, LVEF 26%), complicated by paroxysmal atrial fibrillation and transient ischemic attack.

Intervention

18F-FDG PET/CT imaging followed by intravenous corticosteroid pulses, early introduction of methotrexate, guideline-directed medical therapy (GDMT) for heart failure, and apixaban.

Outcome

Clinical symptom resolution and normalization of left ventricular ejection fraction

18F-FDG PET/CT is critical for diagnosing active cardiac sarcoidosis when CMR is negative, and early synergistic use of methotrexate and GDMT can reverse severe corticosteroid-refractory ventricular dysfunction.

Authors

SNS NafidiCadi Ayyad University SNSana NehameCadi Ayyad University AYAbdelkarim Ait YahyaCadi Ayyad University

Discussion

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Implication

Potential EF recovery in refractory cardiac sarcoidosis with methotrexate plus GDMT; leaves open need for prospective trials.

Cite This Study

Nafidi et al. (2026) studied this question. 18F-FDG PET/CT identified active cardiac sarcoidosis despite a negative MRI, enabling early methotrexate and medical therapy to improve left ventricular ejection fraction from 26% to 52%.

synapsesocial.com/papers/6a3c2364d15afadd906fa10a https://doi.org/10.9734/ca/2026/v15i3549

Topics

Heart failure HFrEF treatment

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Reversible Severe Heart Failure in Corticosteroid-Refractory Cardiac Sarcoidosis: The Crucial Role of 18F-FDG PET/CT in MRI-Negative Disease

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Reversible Severe Heart Failure in Corticosteroid-Refractory Cardiac Sarcoidosis: The Crucial Role of 18F-FDG PET/CT in MRI-Negative Disease

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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