Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

Abstract

A 32‐year‐old man presented with palpitation. He was diagnosed with pulmonary sarcoidosis by lung biopsy. The electrocardiogram showed first‐degree atrioventricular block and complete right bundle branch block (CRBBB). We planned to examine laboratory data, echocardiography, Holter monitoring, and gallium‐67 scintigraphy. Before he went through all these exams, he developed ventricular tachycardia. After defibrillation was performed, his electrocardiogram revealed complete atrioventricular block. We observed elevation of serum angiotensin‐converting enzyme levels. In addition, both of gallium‐67 scintigraphy and 18F‐fluorodeoxyglucose positron emission tomography showed abnormal uptake in the ventricular septum. We diagnosed the patient with cardiac sarcoidosis associated with these arrhythmias. We started treatment with methylprednisolone pulse therapy (1 g daily). After 3 days of steroid pulse therapy, we administered prednisolone 30 mg daily. On day 15, electrocardiogram changed from complete atrioventricular block to first‐degree atrioventricular block and CRBBB. He was discharged with no progression with cardiac sarcoidosis for 2 years.

Cardiac sarcoidosis: A long term follow up study

“…In patients with clinically manifest disease, the extent of left ventricle dysfunction has been reported as a predictor of survival [18][19][20][21][22][23][24]. Despite the lack of randomized controlled trials, the use of moderate to high dose glucocorticosteroids is widely accepted [23][24][25][26][27][28], with the highest quality data related to atrioventricular block [18], left ventricular dysfunction and ventricular arrhythmias [6,[25][26][27]. Immunosuppressant are used as a second-line agent in refractory cases of CS and/or if there are significant steroid side effects [4,29].…”

A Case of Large Sarcoid Choroidal Granuloma Treated with Steroid Pulse Therapy

“…There have been many reports describing the use of steroid pulse therapy for sarcoidosis, including cardiac sarcoidosis [12,13], neurosarcoidosis [14], and pulmonary sarcoidosis [15,16]. With respect to ocular sarcoidosis, a few previous reports described the use of steroid pulse therapy for panuveitis [17] or optic neuropathy [18], yet to the best of our knowledge, there are no previously published reports on choroidal granuloma.…”

A case of cardiac sarcoidosis mimicking cardiac amyloidosis on cardiovascular magnetic resonance

“…Although these findings strongly suggested cardiac amyloidosis, he was finally diagnosed with CS by FDG‐PET ( Figure 4 ), showing invasive uptake in the free wall of the RV and the anteroseptal wall of the LV, and endomyocardial biopsy ( Figure 5 ), showing non‐caseating epithelioid granuloma with giant cells. The patient was treated with methyl prednisolone pulse therapy (1000 mg/day)6 for 3 days, followed by oral prednisolone (30 mg/day). The dosage of prednisolone was gradually reduced.…”