Sarcoidosis with cardiac involvement: a clinical challenge

Autores: Gabriel Andrés Reartes, Gustavo Alberto Pepe, Lucas Santiago Becerra, José Luis Serra, Guillermo Einer Allende, Carla Andrea Gobbi

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Sarcoidosis is a multisystem inflammatory disease that may involve the heart and lead to serious arrhythmias, heart failure, and sudden cardiac death.

We present the case of a 61-year-old woman with long-standing systemic sarcoidosis, initially manifesting as Löfgren syndrome and treated with optimized immunosuppressive therapy, who developed dyspnea, angina, and palpitations more than a decade after the initial diagnosis.

Pulmonary function tests and imaging showed stable chronic pulmonary disease, whereas Holter monitoring revealed atrial flutter with isolated ventricular ectopic beats. Coronary angiography was normal, and cardiac magnetic resonance imaging demonstrated diffuse interstitial fibrosis and septal late gadolinium enhancement consistent with cardiac sarcoidosis.

This case illustrates that cardiac involvement may emerge in late stages, even in phenotypes generally considered to have a favorable prognosis, and highlights the importance of long-term follow-up and the use of advanced cardiac imaging in patients with suggestive symptoms.