A case of sarcoidosis which developed cardiac lesion seven years after the advent of pulmonary lesion

Abstract

A 58-year-old woman, who had been diagnosed as having pulmonary sarcoidosis seven years earlier and had bilateral hilar lymphadenopathy (BHL), admitted to National Saishundo Hospital because of exertional dyspnea. ECG showed complete atrioventricular (AV) block. Cardiomegaly was disclosed on chest X-ray film although BHL had disappeared. Echocardiography showed thinning of wall and abnormal regional wall motion in the basal portion of the ventricular septum. In addition, ²⁰¹T1 myocardial scintigram showed defects of anterior and posterior septum. These findings led to the diagnosis of cardiac sarcoidosis. Signs and symptoms of cardiac failure subsided after placement of an external cardiac pacemaker and conventional treatment for cardiac failure. After the administration of corticosteroid abnormal findings on ²⁰¹T1 myocardial scintigram improved to a certain degree. On the other hand complete AV block was still present which needed a permanent cardiac pacemaker implantation. Abnormal echocardiographic findings of the basal portion of the ventriculer septum remained unchanged. Since the prognosis of sarcoidosis with cardiac involvement is poor, cardiac involvement should be observed carefully in the follow-up of sarcoidosis patients.