A new era of imaging for diagnosis and management of cardiac sarcoidosis: Hybrid cardiac magnetic resonance imaging and positron emission tomography

Excerpt

A 49-year-old African American female with lymph node biopsy-proven pulmonary sarcoidosis complicated by skin and eye involvement presented with dyspnea on exertion. The patient was in her usual state of health until 2 years prior to presentation at which time she reported decreasing exercise tolerance. She otherwise denied chest pain, palpitations, paroxysmal nocturnal dyspnea, orthopnea, lower extremity edema or syncope. She was found on transthoracic echocardiogram (TTE) to have severe mitral regurgitation due to bileaflet mitral valve prolapse and subsequently underwent mitral valve repair with relief of symptoms. She continued to do well until 1 year later, she noted recurrent symptoms with worsening edema. Repeat TTE revealed failure of the prior repair with recurrent severe mitral regurgitation and decline in left ventricular (LV) function. She underwent a mitral valve replacement with bioprosthesis (27 mm Edwards Lifesciences pericardial tissue valve, Magna type). Despite successful replacement and guideline-directed medical therapy (GDMT), patient had repeat hospitalizations for heart failure. Of note, cardiac tissue surrounding the excised mitral valve apparatus at time of MV replacement was notable for non-necrotizing granulomatous inflammation without clear identifiable pathogen. The patient was initiated on prednisone 40 mg daily given histological diagnosis consistent with cardiac sarcoidosis. GDMT was further optimized. She was discharged with a life vest as there was evidence of non-sustained ventricular tachycardia (VT) on telemetry monitoring. She presented for a routine follow-up visit. …