Sarcoidosis is a multisystemic inflammatory disorder characterized by non-caseating granulomas and rarely involves the heart. While frequently presenting without symptoms, cardiac sarcoidosis can lead to arrhythmias, heart failure, and sudden death, with symptoms mimicking other cardiac conditions.
We present a case of a 61-year-old woman admitted to our emergency department in February 2021 with resting dyspnea and atypical chest pain. Elevated hs-troponin and NT-proBNP levels, a new-onset left bundle branch block on ECG, and signs of pulmonary congestion on chest X-ray prompted further investigation. Echocardiography revealed diffuse hypokinesis with akinesia of the mid-apical inferior wall and a significant ventricular dysfunction (LVEF 30%). Coronary angiography excluded lesions, diagnosing MINOCA. Cardiac MRI showed transmural fibrosis without a typical cardiomyopathic pattern. An FDG-PET scan indicated uptake in the heart and lymph nodes. A biopsy of a left supraclavicular lymph node confirmed non-necrotizing granulomas, consolidating the diagnosis of cardiac sarcoidosis. Treatment with Prednisone 25 mg was initiated and gradually tapered to 6.5 mg, leading to a progressive normalization of systolic function (LVEF 56% at 12-month follow-up) and resolution of lymphadenopathies.
Unexplained isolated ventricular dysfunction presents a wide range of potential causes. Despite its rarity, sarcoidosis should be considered as a possible etiology. While characteristic patterns may emerge in cardiac MRI, atypical presentations underscore the need for a comprehensive diagnostic approach. Timely diagnosis and effective treatment can significantly enhance prognosis, emphasizing the importance of prompt intervention for optimal outcomes.
