Great mimicker: definite isolated cardiac sarcoidosis masquerading as hypertrophic cardiomyopathy.

MedStar author(s):
Citation: BMJ Case Reports. 16(12), 2023 Dec 09.PMID: 38087480Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal ArticleSubject headings: *Cardiomyopathy, Hypertrophic | *Myocarditis | *Sarcoidosis | Cardiomyopathy, Hypertrophic/dg [Diagnostic Imaging] | Contrast Media | Gadolinium | Humans | Hypertrophy | Inflammation | Male | Sarcoidosis/pa [Pathology]Year: 2023ISSN:
  • 1757-790X
Name of journal: BMJ case reportsAbstract: A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy. Copyright © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.All authors: Pham T, Abraham J, Sheikh FHFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2024-01-16
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Journal Article MedStar Authors Catalog Article 38087480 Available 38087480

A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy. Copyright © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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