A Case of Possible Isolated Cardiac Sarcoidosis

This case report illustrates challenging aspects of diagnosis of isolated cardiac sarcoidosis. Here, we present a 69-year-old female who had been diagnosed as dilated cardiomyopathy before was admitted to our hospital for congestive heart failure. Coronary angiography showed no significant abnormalities. Left ventriculography revealed left ventricular aneurysm. The endomyocardial biopsy specimens showed no significant findings. Cardiac MRI showed late enhancement at the lateral wall of the left ventricle, this finding suggested the presence of cardiac sarcoidosis. However, Ga citrate scintigraphy and examination of eyes showed no signs of extracardiac sarcoidosis and pulmonary sarcoidosis was excluded by chest CT. Therefore, she did not fulfill the diagnostic criteria for cardiac sarcoidosis. Since then her symptoms gradually worsened and she was readmitted to our hospital for recurrent heart failure in April 2017. During hospitalization, she developed monomorphic sustained ventricular tachycardia. Thus, she met the diagnostic criteria for possible isolated cardiac sarcoidosis. Steroid immunosuppressive therapy was started at this time. Catheter radiofrequency ablation was performed on the 21st hospital day and cardiac resynchronization therapy defibrillator was implanted at a later date. We report a case of possible isolated cardiac sarcoidosis presenting difficulty in diagnosis, mimicking idiopathic dilated cardiomyopathy.