A failed case to diagnose cardiac sarcoidosis presenting advanced atrioventricular block.
A 53-year-old-male developed atrioventricular block in January 2001. A chest X-ray and laboratory tests, including serum angiotensin converting enzyme, were normal. The patient underwent permanent pacemaker implantation and attended for semiannual follow-up after discharge since the etiology of advanced atrioventricular block remains unknown. One year later, the patient was diagnosed with uveitis related to sarcoidosis. No clinical finding specific to cardiac sarcoidosis was notable at that time. Four years after onset, the patient developed congestive heart failure. An echocardiogram revealed diffuse LV hypokinesis, but no asymmetric interventricular septal thinning. Laboratory tests showed normal angiotensin converting enzyme. Noncaseating granuloma was not confirmed by transbronchial biopsy. Despite normal myocardial uptake of gallium-67, uptake of (18)F-Fluorodeoxyglucose increased in the myocardium. Nevertheless, clinical manifestations did not match the criteria for cardiac sarcoidosis. Prednisolone was administered daily. Two months after tapering dosage, the patient developed multiple organ failure and died. Post mortem histological findings were consistent with cardiac sarcoidosis. We experienced great difficulty in detecting cardiac involvement in the early stage of sarcoidosis. A specific method with greater sensitivity is required to diagnose cardiac involvement in the early stages of sarcoidosis.
Morikawa
Mako
M
Kato
Kimihiko
K
Kako
Nobuo
N
Hiramitsu
Shinya
S
Oguri
Mitsutoshi
M
Yajima
Kazuhiro
K
Hibino
Takeshi
T
Kato
Yasuchika
Y
Mizoguchi
Yoshikazu
Y
Kuroda
Makoto
M
Yokoi
Kiyoshi
K
Ichiro Morimoto
Shin
S
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003951:Diagnostic Errors; D017809:Fatal Outcome; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011239:Prednisolone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014605:Uveitis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D019788:Fluorodeoxyglucose F18; D011239:Prednisolone