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Adel K, Bennabi W, Aichaoui F, Meziani S, Morsli A. Sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region: Case report and systematic review. Qatar Med J 2021; 2021:29. [PMID: 34466394 PMCID: PMC8382088 DOI: 10.5339/qmj.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The central nervous system is an unusual location of sarcoidosis, which commonly affects the cranial nerves, meninges, hypothalamus, and pituitary gland. Involvement of the pineal region is extremely rare. This systematic review focused on the diagnosis and management of pineal region sarcoidosis, dorsal mesencephalon, and periaqueductal region. OBJECTIVES This study aimed to discuss diagnostic modalities and best management tools of the aforementioned pathology. METHODS ScienceDirect, PubMed, and Google Scholar databases were searched for English or French articles about sarcoidosis of the pineal region, dorsal mesencephalon, and periaqueductal region. The clinical case of a patient managed at our department that we believe is directly relevant to this review is also presented. Patients' demographics, clinical presentations, presence of hydrocephalus, other sarcoidosis locations in the central nervous system, and medical treatment were collected. Surgical management, surgical approach, and outcomes and complications of each procedure were also obtained. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Fifteen cases were examined. The study sample consisted of nine (60%) male and six (40%) female, and the mean age was 32 years. Eight (53%) patients had hydrocephalus, and the predominant clinical presentations were signs of increasing intracranial pressure (headaches, vomiting, and papilledema). Six (40%) patients had diplopia, and convergence-retraction nystagmus was noted in three (20%) patients. Argyll Robertson sign was present in one patient and suspected in another patient (13%). Medical treatment consisted mainly of steroids (93% of cases). Open surgery on the pineal region was performed in five patients, and four of them reported to have serious complications (such as ophthalmoplegia, hemianopsia, hemiparesis, bilateral third cranial nerve paresis, and cerebellar syndrome). Endoscopic management was performed in two patients without complications. CONCLUSION To treat hydrocephalus, brain imaging is mandatory in patients with sarcoidosis if intracranial hypertension is suspected. In pineal region sarcoidosis, management of hydrocephalus is the priority, followed by medical treatment of the lesion. Open surgery of any approach presents a high risk of complications; thus, an endoscopic approach is the preferred management, as it treats hydrocephalus and makes biopsy possible with minimal risk.
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Affiliation(s)
- Khelifa Adel
- Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail:
| | - Walid Bennabi
- Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail:
| | - Fayçal Aichaoui
- Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail:
| | - Salim Meziani
- Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail:
| | - Abdelhalim Morsli
- Neurosurgical Department, BEO University Hospital, Algiers, Algeria E-mail:
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Bodwal J, Napoleone M, Herath J. Post-mortem CT with macroscopic and microscopic correlation in a case of sudden death due to systemic sarcoidosis. Forensic Sci Med Pathol 2020; 16:544-547. [PMID: 32474826 DOI: 10.1007/s12024-020-00259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
We report a case of sudden death due to systemic sarcoidosis in a fifty-four year old male who was reportedly healthy. A computerized tomography (CT) scan was performed before the autopsy. It showed cardiomegaly with hilar and abdominal lymphadenopathy. The autopsy showed pale yellow plaque deposition on the heart surface which was infiltrating the myocardium. Histological examination of the heart, lungs, liver, and spleen showed extensive sarcoid granulomata which helped in establishing the cause of death.
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Affiliation(s)
- Jatin Bodwal
- Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Saheed Mangal Pandey Marg, Nanak Pura, Hari Nagar, New Delhi, 110064, India. .,Department of Pathobiology and Laboratory Medicine, University of Toronto & Ontario Forensic Pathology Service, Toronto, Ontario, Canada.
| | - Marc Napoleone
- Department of Diagnostic Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Jayantha Herath
- Department of Pathobiology and Laboratory Medicine, University of Toronto & Ontario Forensic Pathology Service, Toronto, Ontario, Canada
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Caruana LB, Redwine GD, Rohde RE, Russian CJ. A prospective study of patients diagnosed with sarcoidosis: factors - environmental exposure, health assessment, and genetic outlooks. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:228-242. [PMID: 32476958 DOI: 10.36141/svdld.v36i3.7112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/01/2019] [Indexed: 12/19/2022]
Abstract
This original research is a directional study that determined the habits of individuals using four analyses to find statistical significance in the data collected from the surveys of 801 qualified of 1,340 individuals who agreed to participate. Results from the self-reported diagnosis of individuals affected by sarcoidosis produced seven statistically significant indicators of future research needed. The demographics revealed a significantly greater number of women and African-Americans participants than other minorities in the United States and suggested a sense of urgency to find a cure. Most important are the seven statistically significant findings that also gave credence to the researchers' four subdiagnostic classifications. They are acute sarcoidosis (AS) and chronic sarcoidosis with limited dissemination (CSLD), while more severe cases include those with chronic sarcoidosis with full dissemination including cutaneous involvement (CSFDIC) and chronic sarcoidosis with neurosarcoidosis (CSN). The most severe sarcoidosis cases (CSN) were on the "most likely" side of every statistically significant category except drinking alcohol, and the "least likely" to participate in physical activities. Conversely, the least severe case of sarcoidosis (AS) was the opposite. The complete list of statistically significant areas was related to alcohol use, tobacco use, ciprofloxacin use, environmental exposure to metals (copper, iron), infectious diseases (candidiasis), genetics, and physical exercise. Statistically, the most crucial study needed; emerged from the Rh blood grouping of the participants.
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Affiliation(s)
| | | | - Rodney E Rohde
- Texas State University Clinical Laboratory Science Program
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Webb M, Conway KS, Ishikawa M, Diaz F. Cardiac Involvement in Sarcoidosis Deaths in Wayne County, Michigan: A 20-Year Retrospective Study. Acad Forensic Pathol 2018; 8:718-728. [PMID: 31240066 PMCID: PMC6490587 DOI: 10.1177/1925362118797744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sarcoidosis is a disease of unknown etiology characterized by the formation of noncaseating, nonnecrotizing granulomas in various organ systems. METHODS Reviews of 84 cases of natural death with sarcoidosis between the years 1996 and 2017 autopsied at Wayne County. RESULTS The median age of decedents was 44 years (29 - 59 years of age). Blacks comprised 95% of the cohort, and 52% were female. Sarcoidosis or direct sequelae were the cause of death in 79% of cases. Twenty-nine percent of patients had a documented history of sarcoidosis and 70% of patients had evidence of systemic sarcoidosis. The most common sites of involvement were lungs or hilar lymph nodes (92%), heart (45%), liver (39%), and spleen (30%). Decedents with cardiac involvement were more likely to have no documented history of sarcoidosis (87% vs. 59%, p=0.004), more likely to have died of a sarcoidosis-related cause (97% vs. 65%, p<0.001), and died at a younger mean age (41 years vs. 46 years, p=0.001). In addition, individuals with cardiac involvement commonly had concurrent multiorgan involvement including lungs (90%), lymph nodes (38%), liver (40%), spleen (32%), and kidneys (7%). CONCLUSIONS Cardiac sarcoidosis is a uniquely poor prognostic factor and carries an increased risk of sudden death as shown by a disproportionate representation among medical examiner cases of sarcoidosis. Our findings suggest that approximately 40% may have asymptomatic cardiac involvement. The distribution of sarcoidosis within our cohort suggests that there is potentially a large undiagnosed and/or underdiagnosed demographic within large urban centers, such as Detroit, Michigan.
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Affiliation(s)
- Milad Webb
- Milad Webb MD PhD, 1301 Catherine Street 5231E Medical Science Bldg I Ann Arbor Michigan 48109-5602,
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Sudden unexpected death due to severe pulmonary and cardiac sarcoidosis. Forensic Sci Med Pathol 2016; 12:319-23. [PMID: 27379608 DOI: 10.1007/s12024-016-9792-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/26/2022]
Abstract
In this paper we report the autopsy findings of a 57 year old woman who died unexpectedly at home. She had been complaining of shortness of breath, episodes of dry coughing, and nausea. Her past medical and social history was unremarkable. She had no previous history of any viral or bacterial disease and no history of oncological disorders. Autopsy revealed multiple grayish-white nodular lesions in the pleura and epicardial fat and areas resembling fibrosis on the cut surface of the anterior and posterior wall of the left ventricle and interventricular septum. Histological examination of the lungs and heart revealed multiple well-formed noncaseating epithelioid cell granulomas with multinucleated giant cells. Death was attributed to myocardial ischemia due to vasculitis of intramural coronary artery branches associated with sarcoidosis. Sarcoidosis is a multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas in the affected organs and tissues. The diagnosis of sarcoidosis in this case was established when other causes of granulomatous disease such as tuberculosis, berylliosis, hypersensitivity pneumonitis, and giant cell myocarditis had been reasonably excluded.
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Byard RW. Lethal Epistaxis. J Forensic Sci 2016; 61:1244-9. [PMID: 27282512 DOI: 10.1111/1556-4029.13119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/24/2015] [Accepted: 11/15/2015] [Indexed: 12/18/2022]
Abstract
Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51-year-old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77-year-old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2-year-old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia. .,School of Medicine, Level 3 Medical School North Building, The University of Adelaide, Frome Rd, Adelaide, 5005, Australia.
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Kanaroglou S, Nair V, Fernandes JR. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis. Cardiovasc Pathol 2015; 24:244-6. [PMID: 25638512 DOI: 10.1016/j.carpath.2015.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/31/2014] [Accepted: 01/01/2015] [Indexed: 12/16/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy.
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Affiliation(s)
- Savas Kanaroglou
- Hamilton Centre for Kidney Research, St. Joseph's Hospital, Hamilton, Ontario, Canada L8N 4A6.
| | - Vidhya Nair
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS.
| | - John R Fernandes
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS.
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Dettmeyer RB. The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol 2014; 10:401-12. [PMID: 24577850 DOI: 10.1007/s12024-014-9536-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 12/19/2022]
Abstract
The role of forensic histopathology in routine practice is to establish the cause of death in particular cases. This is achieved on the basis of microscopic analysis of representative cell and tissue samples taken from the major internal organs and from abnormal findings made at autopsy. A prerequisite of this is adherence to the quality standards set out for conventional histological/cytological staining and enzyme histochemical and immunohistochemical methods. The interpretation of histological findings is performed by taking into account macroscopic autopsy findings and information on previous history. Histological analysis may prompt postmortem biochemical and chemical-toxicological investigations. The results of histological analysis need to be classified by experts in the context of the available information and the need to withstand the scrutiny of other experts.
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Affiliation(s)
- R B Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig University Giessen, Frankfurter Str. 58, 35392, Giessen, Germany,
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Kubat B, van Suylen RJ. An unusual cardiomyopathy in a cocaine user. Forensic Sci Med Pathol 2012; 9:125-7. [PMID: 22752991 DOI: 10.1007/s12024-012-9356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Bela Kubat
- Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands.
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Birkenbach C, Schröder AS, Sperhake JP. Sudden death due to pulmonary embolism in a patient with cardiac sarcoidosis. Forensic Sci Med Pathol 2012; 8:466-9. [PMID: 22706660 DOI: 10.1007/s12024-012-9353-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Carla Birkenbach
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
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D’Errico S, Bello S, Cantatore S, Neri M, Riezzo I, Turillazzi E, Fineschi V. Immunohistochemical characterisation and TNF-α expression of the granulomatous infiltration of the brainstem in a case of sudden death due to neurosarcoidosis. Forensic Sci Int 2011; 208:e1-5. [PMID: 21353407 DOI: 10.1016/j.forsciint.2011.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 11/28/2010] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Cecchetto G, Viel G, Amagliani A, Boscolo-Berto R, Fais P, Montisci M. Histological diagnosis of myocardial sarcoidosis in a fatal fall from a height. J Forensic Sci 2010; 56 Suppl 1:S255-8. [PMID: 20950322 DOI: 10.1111/j.1556-4029.2010.01603.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The major issues of medico-legal relevance in fatal falls from a height are the manner of death and the reconstruction of the event. We present a peculiar case of a fatal fall from a height of about 9 m, involving a 27-year-old woman. At the death scene investigation, no suicide notes, housebreaking marks, or signs of fight were found, thus weakening both the suicide and homicide hypotheses. Combining circumstantial, autopsy and toxicology data, the kinematic analysis of the jump/fall, and the histological evidence of a myocardial sarcoidosis involving the left ventricle, we hypothesized that the young woman might have accidentally fallen from the window because of a sudden loss of consciousness related to cardiac disease undiagnosed during life. We believe that our brief report is a good example of the powerful additional information that histological investigations can offer for reconstructing the dynamics of the event in falls from a height and other traumatic fatalities.
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Affiliation(s)
- Giovanni Cecchetto
- Department of Environmental Medicine and Public Health, University of Padova, Italy.
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Unusual cardiovascular manifestations of sarcoidosis, a report of three cases: coronary artery aneurysm with myocardial infarction, symptomatic mitral valvular disease, and sudden death from ruptured splenic artery. Cardiovasc Pathol 2010; 19:e119-23. [DOI: 10.1016/j.carpath.2009.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/24/2009] [Accepted: 04/14/2009] [Indexed: 11/18/2022] Open
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Matejic D, Schönfeld C, Tsokos M. Plötzlicher Tod bei akuter idiopathischer Riesenzellmyokarditis. Rechtsmedizin (Berl) 2010. [DOI: 10.1007/s00194-010-0686-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.
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Mehrhof F, Stockburger M, Schuette H, Haverkamp W, Dietz R. Ventricular tachycardia as the first manifestation of cardiac sarcoidosis. BMJ Case Rep 2009; 2009:bcr08.2008.0810. [PMID: 21686620 PMCID: PMC3028065 DOI: 10.1136/bcr.08.2008.0810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The case of a 32-year-old man with sustained ventricular tachycardia and hypotension is described. Following pharmacological treatment the patient switched to a sinus rhythm and was transferred to a university hospital for further diagnostic procedures and treatment. Cardiac catherisation ruled out underlying coronary artery disease, and cardiac MRI as well as echocardiography demonstrated a moderately reduced left ventricular ejection fraction, marked thickening of the interventricular septum and extensive intramural and epicardial infiltration of both ventricles. Endomyocardial biopsies were inconclusive; an implantable cardioverter defibrillator (ICD) was implanted in order to prevent a fatal arrhythmic event. Only repeated lymph node biopsies revealed typical findings of granulomatous disease, which together with the clinical course and the cardiac MRI findings strongly supported cardiac sarcoidosis. A few days after initiation of therapy with corticosteroids, the patient experienced the first of a number of ICD discharges, demanding aggressive anti-arrhythmic treatment regimen for the future.
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Affiliation(s)
- Felix Mehrhof
- Charité University Medicine Berlin, Cardiology, Augustenburger Platz 1, Berlin, 13353, Germany
- German Competence Network of Heart Failure, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Martin Stockburger
- Charité University Medicine Berlin, Cardiology, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Hartwig Schuette
- Charité University Medicine Berlin, Infectious Diseases and Respiratory Medicine, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Wilhelm Haverkamp
- Charité University Medicine Berlin, Cardiology, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Rainer Dietz
- Charité University Medicine Berlin, Cardiology, Augustenburger Platz 1, Berlin, 13353, Germany
- German Competence Network of Heart Failure, Augustenburger Platz 1, Berlin, 13353, Germany
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Riezzo I, Ventura F, D’Errico S, Neri M, Turillazzi E, Fineschi V. Arrhythmogenesis and diagnosis of cardiac sarcoidosis. An immunohistochemical study in a sudden cardiac death. Forensic Sci Int 2009; 183:e1-5. [PMID: 19019592 DOI: 10.1016/j.forsciint.2008.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 07/05/2008] [Accepted: 09/23/2008] [Indexed: 11/29/2022]
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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