Challenging differential diagnosis, Rare coexistence of disease or pathology
Hannah K. Gendelman, Marwa Sabha, Anton A. Gryaznov, Bernadette C. Siaton
Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Am J Case Rep 2021; 22:e927331
Available online: 2020-12-14
Cardiac sarcoidosis and large-vessel vasculitis are both rare diseases with a variety of presenting symptoms. Both can result in high morbidity and mortality if not diagnosed early. While they are each relatively uncommon on their own, there have been a few reports suggesting they may be more related than previously thought. This case report suggests that the 2 diseases can become symptomatic concurrently, complicating diagnosis.
CASE REPORT: A 68-year-old male patient was diagnosed concurrently with cardiac sarcoidosis and vasculitis after several episodes of syncope thought to be due to arrhythmia. The patient was treated with high-dose corticosteroids, and repeat imaging showed decreased inflammatory changes in the cardiac tissue and large blood vessels.
CONCLUSIONS: Prior case reports have described vasculitis and sarcoidosis in the same patient; however, these patients usually had a long history of known sarcoidosis involving several organ systems. This case suggests that physicians should be alert to more limited forms of the disease in a patient with cardiac myopathy of unknown origin with new arrythmia. More research is also needed to determine how granulomatous disease and vasculitis are related to each other.
Keywords: sarcoidosis, Syncope, Vasculitis