SESSION TYPE: Miscellaneous Case Report Posters II
PRESENTED ON: Tuesday, October 23, 201 at 01:30 PM - 02:30 PM
INTRODUCTION: Patients with sarcoidosis are susceptible to the development of various manifestations of infiltrative disease including cardiac involvement. Cardiac manifestations range from conduction system aberrancies to myocardial infiltration. Pericardial manifestations are rarely described.
CASE PRESENTATION: A 68 yo man with multi-organ sarcoidosis and diabetes mellitus presented with complaints of 4 days of worsening dyspnea and subjective fevers. The patient was on outpatient corticosteroid therapy and infliximab with recently negative fungal and tubercular studies. He was in his usual state of health 2 weeks before admission when his outpatient pulmonologist initiated a corticosteroid taper. Admission radiograph demonstrated increase in chronic interstitial changes. EKG was consistent with baseline studies including normal intervals and ST segments. Exam revealed mild hypoxemia, relative hypotension, coarse pulmonary crackles, distant heart sounds and 1+ bilateral lower extremity edema. VQ scan showed low probability of pulmonary embolism. Transthoracic echocardiogram showed normal systolic function, PA systolic pressure of 61mmHg, a moderate pericardial effusion composed primarily of peri-right ventricular fibrinous organized material and a small focal mass attached to the LV surface without evidence of collapse in any chamber. Right heart catheterization demonstrated CVP of 15 mmHg, PCWP of 8 mmHg, PA pressure of 40/20 mmHg and systemic BP of 185/101 mmHg. The patient was given corticosteroids, antibiotics and diuresis. On day 4, he became hypercapnic and altered, prompting initiation of mechanical ventilation. Bronchoalveolar lavage cultures grew Enterobacter cloacae. Therapy continued with significant clinical improvement. Cardiac MRI demonstrated an abnormal focus of enhancement within the inferior LV wall consistent with infiltrative disease. The previously noted effusion was not visualized. The patient continued on corticosteroids and was discharged at baseline level of cardiopulmonary functionality.
DISCUSSION: The finding of a fibrinous pericardial mass may be an atypical cardiac manifestation of sarcoidosis but did not appear to have clinical significance in this patient’s presentation.
CONCLUSIONS: This case illustrates the importance of using the preponderance of data in clinical decision making. Although the patient had a fibrinous mass on echocardiogram, his symptomatology primarily stemmed from pneumonia and sepsis in the setting of immunosuppresion.
1) Uma S. Ayyala, Ajith P Nair, Maria L Padilla. Cardiac Sarcoidosis. Clin Chest Med 29 (2008) 493-508.
DISCLOSURE: The following authors have nothing to disclose: Patrick Aguilar, Karla Diaz, Diego Maselli, Adriel Malave, Marcos Restrepo
No Product/Research Disclosure InformationUniversity of Texas Health Science Center San Antonio, San Antonio, TX