Sarcoidosis with Cardiac Localization: About 03 Cases

Background: Cardiac involvement in sarcoidosis is a serious localization that needs to be recognized, that’s why we report three cases of cardiac sarcoidosis, each with a different clinical presentation.

Case Presentation: In the first patient, cardiac involvement was revealed by exertional dyspnea and palpitations, which led to transthoracic echocardiography (TTE) showing 30% left ventricular dysfunction. In the second patient, cardiac localization was discovered following lipothymic malaise associated with complete atrioventricular block, for which a pacemaker was implanted. In the third patient, the workup for atypical precordialgia revealed signs of cardiac sarcoidosis. Magnetic resonance imaging (MRI) revealed abnormalities compatible with cardiac localization of sarcoidosis in the first patient, presenting with left ventricular dysfunction on TTE. In the second patient, it showed no abnormalities, while in the third, it was not performed. Positron emission tomoscintigraphy (PET/CT) in all three patients revealed signs of metabolic hyperactivity in the first and third patients. In the second patient, who presented with atrioventricular block (AVB), the scan showed no abnormalities, and the diagnosis of cardiac sarcoidosis was based solely on the presence of atrioventricular conduction disorder. All our patients benefited from long-term corticosteroid therapy, associated with the first patient with courses of methotrexate due to the presence of left ventricular dysfunction. The latter also received background treatment for chronic heart failure. After a follow-up of 11, 4 and 2 years respectively for the first, second and third patients, the evolution was favorable, with stable left ventricular function in the first patient and no symptomatological worsening in all three patients.

Conclusion: Cardiac sarcoidosis is a serious localization that needs to be detected on the basis of a clinical workup, complemented by imaging a cardiac MRI or PET scan, in order to confirm the diagnosis and propose specific treatment.