Two Cases in Which Cardiac Sarcoidosis was Strongly Suspected Despite not Fulfilling the Diagnostic Guideline

概要

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It is often difficult to diagnose cardiac sarcoidosis according to presently available guideline, because the detection rate on cardiac biopsy is low. We report here two cases in which cardiac sarcoidosis could not be diagnosed by guideline but was strongly suspected. In both cases serum angiotensin converting enzyme and lysozyme levels were elevated, and sarcoidosis was diagnosed by lung biopsy. In one case right axis deviation was seen, while in the other no abnormalities were apparent on ECG. Neither case showed any particular abnormalities on Holter ECG or echocardiography. However, both showed diffuse spotty decreased uptake on Thallium-201-BMIPP myocardial scintigraphy. Endomyocardial biopsy did not reveal epithelioid cell granuloma. On coronary angiography no significant stenosis was noted, and the marked spotty decreased uptake on myocardial scintigraphy strongly suggested cardiac lesion of sarcoidosis. Our cases suggest that there exist some cases in which cardiac sarcoidosis cannot be diagnosed by the presently available guidline. We believe that this is an important issue to be addressed in the area of diagnosis of cardiac sarcoidosis.
日本サルコイドーシス/肉芽腫性疾患学会の論文