Abstract
Background:
Cardiac sarcoidosis has a prevalence of 2-3% and the major cause of death in patients with systemic sarcoidosis. The noncaseating granuloma forms in cardiac tissue mainly in the ventricular myocardium, which affects the conduction system and can lead to arrhythmia, heart failure, and sudden cardiac death. The natural history of sarcoidosis is highly variable and there is limited literature on cardiac involvement. We describe a case of heart block in a young adult patient with sarcoidosis.
Case presentation:
A 40-year-old African American female with a history of hypertension presented to the clinic with 7 days of dyspnea on exertion, headache, and dizziness. On examination vitals were normal, a chest x-ray showed cardiomegaly, bilateral (B/L) hilar lymphadenopathy, mediastinal lymphadenopathy, and multiple lung nodules. Her ECG showed 2:1 AV block and right bundle branch block, followed by echocardiography which revealed right ventricular infiltration and reduction in systolic dysfunction. Based on these findings, differential diagnoses of mediastinal lymphoma, tuberculosis, and sarcoidosis were considered and evaluated. The patient did not have a travel history. The cervical lymph node biopsy showed noncaseating granuloma which confirmed a diagnosis of sarcoidosis. The patient was given corticosteroid 60 mg OD and a permanent pacemaker was implanted. After three months of follow up, patient showed an improvement, and echocardiography findings subsided
Case discussion:
In our case, a young female presented with nausea, dizziness, and headache, with 2:1 AV block on ECG and noncaseating granuloma on biopsy indicating cardiac sarcoidosis. Cardiac involvement can occur at any point during sarcoidosis. The AV block in young patients should raise the suspicion of sarcoidosis and if it is associated with CHF or arrhythmias and can lead to sudden cardiac death. Hence, early diagnosis is vital to enable prompt management and improve the prognosis.
Conclusion:
Our case presents the diagnostic challenge of cardiac sarcoidosis in healthy young adults with AV block. Early treatment with steroids is recommended in systemic sarcoidosis to prevent fatal cardiac complications.
