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Abstract Background Sarcoidosis is a great mimicker of various medical conditions which leads to obstacles in early diagnosis and appropriate timely management. Case Description A 66-year-old Indian female with metabolic syndrome was initially treated for decompensated liver disease. Her baseline ECG showed RBBB with a first-degree heart block. She presented 3 months later with angina and heart failure (HF) symptoms, complicated with VT treated with IV amiodarone and anti-failure medication. Her coronary angiogram revealed mild disease, and her echocardiography showed a mildly reduced ejection fraction (EF) of 45% with RWMA. Cardiac MRI revealed non-specific left ventricular (LV) patchy mid-wall to epicardial LGE. Endomyocardial biopsy was complicated with cardiac tamponade and required pericardiocentesis followed by dual chambers ICD later. Unfortunately, biopsy result was inconclusive, and serum ACE was within the normal range. She had multiple admissions for past 2 years for recurrent VT and decompensated HF despite the optimization of ICD setting and guideline-directed medical therapy. Repeated ECHO revealed similar EF with thinning of the LV basal septal segment. Her PET scan (Tc-99m) showed diffuse uptake at the LV myocardium and supraclavicular/mediastinal/abdominopelvic lymph nodes with a mismatch of FDG uptake at the basal-inferolateral segment (non-specific). Lymph node biopsy revealed chronic non-caseating granulomatous inflammation. Clinical diagnosis of cardiac sarcoidosis was made based on a histologic diagnosis of extracardiac sarcoidosis with cardiomyopathy/ventricular arrhythmia combined with PET/CMR findings. Conclusion Cardiac sarcoidosis can have a myriad of symptoms which may mimic several other disorders leading to a diagnostic challenge.
Hassan et al. (Fri,) studied this question.