An 82-year-old man was admitted to our hospital to investigate the asynergy in apex and the wall thinning in intraventricular septum (IVS) on echocardiography. Twenty-seven years ago, he was diagnosed with hypertrophic cardiomyopathy (HCM) by negative T waves in the electrocardiogram and significant hypertrophy in the IVS and apex on echocardiography. Although he had no symptom, the endo-myocardial biopsy was performed to diagnose the abnormal changes in myocardium which had been worsened in this two years. Pathology showed typical findings for cardiac sarcoidosis (CS) with epithelioid cell granulomas. Although the differential diagnosis between CS with left ventricular hypertrophy and HCM is difficult, the long-term routine follow-up by echocardiography is necessary in patients with severe left ventricular hypertrophy not to miss the slight morphological change of CS.
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