[Pulmonary and cardiac recurrence of sarcoidosis in a heart transplant recipient].
METHODS
A 38-year-old man underwent heart transplantation for end-stage heart failure as a result of sarcoid cardiomyopathy. Routine post-transplantation endomyocardial biopsies demonstrated no graft rejection. However, six months post-transplantation, while on immunosuppressive medication, the patient noted a dry cough.


METHODS
Cardiovascular magnetic resonance imaging (MRI) showed recurrent sarcoidosis in the transplanted heart, and bronchoscopy revealed granulomas consistent with pulmonary sarcoidosis. The chest radiograph revealed bilateral perihilar interstitial nodular infiltration. Whole blood analysis, coagulation and electrolyte parameters as well as inflammatory and enzyme values were within the normal range.


METHODS
The patient was treated with an increased dosage of prednisone. Furthermore, the immunosuppression with cyclosporin and everolimus was replaced by cyclosporin and azathioprine. Regular pulmonary function tests were done in addition to the routine biopsy controls and the laboratory tests as well as electrocardiography, echocardiography and radiography. The patient has remained well at eighteen months after transplantation.


CONCLUSIONS
For those patients who develop end-stage cardiomyopathy from sarcoidosis, heart transplantation is still the therapy of choice. The recurrence of sarcoidosis in a transplanted heart has been only very rarely reported in the literature. Once recurrence is diagnosed patients should be treated with an increased dosage of steroid in addition to standard immunosuppressives.
Strecker
Th
T
Zentrum für Herzchirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. thomas.strecker@herz.imed.uni-erlangen.de
Zimmermann
I
I
Wiest
G H
GH
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000188:drug therapy / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011184:Postoperative Period; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012507:Sarcoidosis / Q000188:drug therapy / Q000601:surgery*; D017565:Sarcoidosis, Pulmonary / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone