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Ventricular tachycardia - an atypical initial presentation of sarcoidosis: a case report.

Ekka M, Sinha S, Purushothaman R, Naik N, Narang R, Singh L - J Med Case Rep (2013)

Bottom Line: Although clinically apparent cardiac sarcoidosis is an uncommon entity, ventricular tachyarrhythmias as the first presenting symptom are very rare.We discuss the case of a 41-year-old Asian woman who presented to our hospital with intermittent palpitation and on evaluation was diagnosed to have systemic sarcoidosis with cardiac involvement.She was started on multiple antiarrhythmic drugs and corticosteroids without any satisfactory response.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. drsanjeevsinha2002@yahoo.com.

ABSTRACT

Introduction: Symptomatic cardiac involvement is seen in less than 5% of all cases of sarcoidosis. Although clinically apparent cardiac sarcoidosis is an uncommon entity, ventricular tachyarrhythmias as the first presenting symptom are very rare.

Case presentation: We discuss the case of a 41-year-old Asian woman who presented to our hospital with intermittent palpitation and on evaluation was diagnosed to have systemic sarcoidosis with cardiac involvement. She was started on multiple antiarrhythmic drugs and corticosteroids without any satisfactory response.

Conclusions: Our case report indicates that sarcoidosis can manifest as ventricular tachycardia without any detectable systemic findings. This makes sarcoidosis an important diagnostic consideration in patients with ventricular tachycardia of unknown origin given the high mortality associated with ventricular tachyarrhythmias.

No MeSH data available.


Related in: MedlinePlus

Skin biopsy showing non-caseating discrete granuloma (arrow) (×200, hematoxylin and eosin stain).
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Figure 4: Skin biopsy showing non-caseating discrete granuloma (arrow) (×200, hematoxylin and eosin stain).

Mentions: To evaluate the extent of the disease an 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET)-CT scan was performed. The study showed evidence of active disease involving her bilateral lungs, mediastinal, right supraclavicular, peripancreatic and retrocrural lymph nodes with focal lesions in segments VII and VIII of her liver (Figure 3). As the supraclavicular node was not palpable, a biopsy was attempted from the superficial lesion in the right lobe of her liver. This biopsy showed interstitial fibrosis but no evidence of epithelioid granulomas. A skin biopsy from a waxy papule of her lower limb showed non-caseating epithelioid cell granuloma suspicious for sarcoidosis (Figure 4). A Ziehl–Neelsen stain showed an absence of acid-fast bacilli. A diagnosis of systemic sarcoidosis with suspected cardiac involvement was made. Bronchoscopy with transbronchial lung biopsy was not attempted because systemic sarcoidosis had already been confirmed with skin biopsies and further intervention in an unstable patient was considered unnecessary.


Ventricular tachycardia - an atypical initial presentation of sarcoidosis: a case report.

Ekka M, Sinha S, Purushothaman R, Naik N, Narang R, Singh L - J Med Case Rep (2013)

Skin biopsy showing non-caseating discrete granuloma (arrow) (×200, hematoxylin and eosin stain).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750302&req=5

Figure 4: Skin biopsy showing non-caseating discrete granuloma (arrow) (×200, hematoxylin and eosin stain).
Mentions: To evaluate the extent of the disease an 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET)-CT scan was performed. The study showed evidence of active disease involving her bilateral lungs, mediastinal, right supraclavicular, peripancreatic and retrocrural lymph nodes with focal lesions in segments VII and VIII of her liver (Figure 3). As the supraclavicular node was not palpable, a biopsy was attempted from the superficial lesion in the right lobe of her liver. This biopsy showed interstitial fibrosis but no evidence of epithelioid granulomas. A skin biopsy from a waxy papule of her lower limb showed non-caseating epithelioid cell granuloma suspicious for sarcoidosis (Figure 4). A Ziehl–Neelsen stain showed an absence of acid-fast bacilli. A diagnosis of systemic sarcoidosis with suspected cardiac involvement was made. Bronchoscopy with transbronchial lung biopsy was not attempted because systemic sarcoidosis had already been confirmed with skin biopsies and further intervention in an unstable patient was considered unnecessary.

Bottom Line: Although clinically apparent cardiac sarcoidosis is an uncommon entity, ventricular tachyarrhythmias as the first presenting symptom are very rare.We discuss the case of a 41-year-old Asian woman who presented to our hospital with intermittent palpitation and on evaluation was diagnosed to have systemic sarcoidosis with cardiac involvement.She was started on multiple antiarrhythmic drugs and corticosteroids without any satisfactory response.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. drsanjeevsinha2002@yahoo.com.

ABSTRACT

Introduction: Symptomatic cardiac involvement is seen in less than 5% of all cases of sarcoidosis. Although clinically apparent cardiac sarcoidosis is an uncommon entity, ventricular tachyarrhythmias as the first presenting symptom are very rare.

Case presentation: We discuss the case of a 41-year-old Asian woman who presented to our hospital with intermittent palpitation and on evaluation was diagnosed to have systemic sarcoidosis with cardiac involvement. She was started on multiple antiarrhythmic drugs and corticosteroids without any satisfactory response.

Conclusions: Our case report indicates that sarcoidosis can manifest as ventricular tachycardia without any detectable systemic findings. This makes sarcoidosis an important diagnostic consideration in patients with ventricular tachycardia of unknown origin given the high mortality associated with ventricular tachyarrhythmias.

No MeSH data available.


Related in: MedlinePlus