Massive pericardial effusion causing cardiac tamponade accompanied by elevated CA-125 and thoracic lymphadenopathy in sarcoidosis: a case report

Abrupt Onset of Cardiac Tamponade in Sarcoidosis

“…As far as we know, an open biopsy of the pericardium was performed in six patients with cardiac tamponade who were finally diagnosed with sarcoidosis. 6,7,9,13,16,17) In those six patients, four had a positive histological findings for sarcoidosis, although repeated resection of the pericardium was needed to yield a positive result in two cases. 7,16) Therefore, although an open biopsy of the pericardium may be an acceptable diagnostic strategy, especially in patients who do not have a typical manifestation and history of sarcoidosis, it is unlikely to be sufficient to exclude the possibility of sarcoidosis, possibly due to a patchy distribution of granuloma foci.…”

“…1,4) We searched the English literature in the PubMed database (January 1970 to September 2018) using "sarcoidosis, tamponade" and "sarcoidosis, pericardial effusion" as searching words and found 13 cases of sarcoidosis with cardiac tamponade (Table II). [5][6][7][8][9][10][11][12][13][14][15][16][17] In addition, several reports on patients with sarcoidosis complicated by massive pericardial effusion without tamponade physiology were also found. [18][19][20] Although it is difficult to exclude the possibility that he had acute viral pericarditis in the present case since the diagnosis of acute viral pericarditis is made by the exclusion of other causes of pericarditis, preceding development of muscular sarcoidosis suggests pericardial involvement in sarcoidosis.…”

“…9,10,[13][14][15] Conversely, two patients who did not have reaccumulation of pericardial fluid after pericardial drainage without steroid therapy were also reported. 12,17) Thus, glucocorticoid is also likely to be a cornerstone drug in sarcoidosis with cardiac tamponade, but further accumulation of cases is needed to demonstrate the effect of steroid therapy on pericardial manifestation of sarcoidosis.…”

“…Although symptoms such as chest pain, dyspnea, syncope, and edema prior to the development of cardiac tamponade were found in previously reported sarcoidosis cases, [5][6][7][8][9][10][11][12][13][14][15][16][17] our case did not have any symptoms and findings suggesting cardiac sarcoidosis at the time when symptoms of muscular sarcoidosis appeared as shown in Figure 1A and C. However, small pericardial effusion together with conduction disturbances appeared 2 weeks later (Figure 1A and C, and Figure 2A), followed by abrupt onset of cardiac tamponade (Figure 2B). The clinical course of this case was not consistent with those of previously reported sarcoidosis cases.…”

Diagnostic value of elevated serum carbohydrate antigen 125 level in sarcoidosis

“…Limited publications, including case reports and literature reviews, have focused on the association between pulmonary sarcoidosis and CA125 levels so far. Those previous studies have indicated that elevated levels of CA125 in sarcoidosis patients are related to pleural effusion, peritoneal involvement, liver, spleen, and pulmonary abnormalities, and pericardial effusion[ 10 , 30 ]. In particular, Kudaiberdiev et al [ 30 ] reported a case of cardiac sarcoidosis with severe pericardial effusion and increased CA125 levels; histological examination of the pericardial lymph node specimen validated the diagnosis.…”