A78-26 Fulminant Multisystem Decline in Cardiac Sarcoidosis Presenting With Refractory Encephalopathy and Multiorgan Failure: A Case Report

Abstract Rationale Sarcoidosis is a systemic granulomatous disorder that can cause cardiac and neurologic involvement, but rapidly progressing fulminant presentations with multiorgan failure remain uncommon. Cardiac sarcoidosis may manifest with conduction abnormalities, arrhythmias, and end-stage cardiomyopathy. We present a rare case of progressive cardiac sarcoidosis complicated by refractory metabolic encephalopathy, renal failure, and respiratory compromise leading to terminal decline despite maximal multidisciplinary management. Methods A 68-year-old woman with biopsy proven sarcoidosis, hypertension, myocardial infarction, DVT, and chronic heart failure was admitted with five days of worsening lethargy, poor intake, and outpatient laboratory evidence of hypernatremia and hyperammonemia. Clinical, laboratory, and imaging data were obtained throughout her hospitalization. Cardiology, nephrology, infectious disease, and palliative care were consulted. Interventions included targeted antibiotic therapy, volume optimization, metabolic correction, and evaluation for advanced heart-failure therapies. Results Admission sodium was 148 mmol/L, BUN 120 mg/dL, creatinine 3.09 mg/dL (eGFR 16 mL/min/1.73 m²), WBC 12.8 x10E3/uL, and hemoglobin 8.1 g/dL. Imaging demonstrated complete left-lung atelectasis and right-lower-lobe consolidation. Bronchoalveolar lavage cultured Proteus ESBL, successfully treated with a 10-day course of meropenem. Despite infection control and metabolic stabilization, encephalopathy persisted. Echocardiography revealed severe biventricular dysfunction consistent with ACC/AHA Stage D heart failure, likely secondary to cardiac sarcoidosis. On hospital day 5, she suffered ventricular-fibrillation arrest, was resuscitated, and briefly supported with intra-aortic balloon counterpulsation. She subsequently developed progressive renal dysfunction and hemodynamic instability. Following goals-of-care discussions, she was compassionately extubated and transitioned to comfort-measures-only care. The patient expired peacefully. Conclusions This case illustrates the catastrophic potential of systemic sarcoidosis when cardiac involvement leads to end-stage heart failure and multiorgan dysfunction. Despite broad-spectrum antimicrobials, advanced cardiac support, and multidisciplinary management, the disease course was irreversible. Early identification of cardiac sarcoidosis, timely immunosuppression, and integration of palliative care are critical to improving quality of life and guiding decision-making in advanced disease. This abstract is funded by: none