The challenging management of cardiac involvement in systemic sarcoidosis

Abstract

A 34 year-old young man came to our attention after an occasional finding of complete AV block. We made the diagnosis of systemic sarcoidosis with cardiac involvement through an FDG-PET even with a normal CMR. We started corticosteroid therapy and we decided to follow-up the patient through an implantable loop recorder (ILR). Beyond an initial regression of the AV block, after 8 months the ILR revealed AV block and pauses more than 3 s during the day; a new FDG-PET evidenced FDG uptake in new areas of left ventricle. Hence we started infliximab and implanted a dual chamber ICD.

Keywords:

• AV block
• cardiac sarcoidosis
• ILR

Disclosure statement

No potential conflict of interest was reported by the author(s).

Figure 1. FDG-PET showing systemic localization of granulomas (Panel A), FDG cardiac uptake within the heart (Panel B), only few lung FDG uptake persistence after corticosteroid therapy (Panel C), no more cardiac uptake (Panel D).