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Lemay S, Jeantin C, Kyomi Labelle F, Philippon F, Beaudoin J, Albert A, Dion G, Trottier M, Dubois M, Charbonneau É, Gleeton G, Massé C, Raymond C, Birnie DH, Sénéchal M. Concomitant symptomatic cardiac sarcoidosis and systemic sclerosis with cardiac involvement: a case report. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:283-290. [PMID: 37736350 PMCID: PMC10509454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Sarcoidosis and systemic sclerosis are two inflammatory multisystemic disorders of unknown etiology that may be life-threatening especially when there is cardiac involvement. Both diseases may coexist, however, there are very few case reports of patients with both cardiac sarcoidosis and systemic sclerosis in the literature. We report the case of a 72-year-old female who was initially referred for dyspnea. A chest computed tomography scan showed multiple hilar and mediastinal adenopathy with a non-specific opacity in the middle pulmonary lobe. FDG-PET-scan showed increased FDG uptake in the adenopathy, the middle lobe and the right ventricular free wall. Sarcoidosis was confirmed with a lung biopsy. Both electrocardiogram and echocardiogram were normal. Four months later, the patient developed a high-grade atrioventricular block deemed secondary to her cardiac sarcoidosis. Two years later, the patient was referred to a rheumatologist for severe Raynaud's symptoms, sclerodactyly and acrocyanosis. After thorough investigations, a diagnosis of limited cutaneous systemic sclerosis with systemic and cardiac sarcoidosis was made. This case demonstrates that both cardiac sarcoidosis and systemic sclerosis may coexist. In the literature, either disease may come first. In cases where cardiac symptoms appear after the diagnosis of concomitant sarcoidosis and systemic sclerosis, it might be difficult for clinicians to confirm which disease is responsible for the heart involvement. This is important since early cardiac sarcoidosis treatment should be done to prevent major complications and may well differ from systemic sclerosis treatment. In this review, we discuss the main clinical manifestations and imaging findings seen with cardiac disease secondary to sarcoidosis and systemic sclerosis.
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Affiliation(s)
- Sylvain Lemay
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Carla Jeantin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Frédérique Kyomi Labelle
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - François Philippon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Alexandra Albert
- Department of Rheumatology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Geneviève Dion
- Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Mikaël Trottier
- Department of Nuclear Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Michelle Dubois
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Éric Charbonneau
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Guylaine Gleeton
- Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Charles Massé
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - Cédric Raymond
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
| | - David H Birnie
- Department of Cardiology, University of Ottawa Heart InstituteOttawa, Ontario, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval UniversityQuébec, Canada
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De Carvalho J. A sarcoidosis patient developing psoriatic arthritis 18 years later: first description. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023014. [PMID: 37382077 PMCID: PMC10494749 DOI: 10.36141/svdld.v40i2.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/21/2023] [Indexed: 06/30/2023]
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Nelson T, Leung B, Bannykh S, Shah KS, Patel J, Dumitrascu OM. Cerebral Amyloid Angiopathy-Related Inflammation in the Immunosuppressed: A Case Report. Front Neurol 2019; 10:1283. [PMID: 31866934 PMCID: PMC6908508 DOI: 10.3389/fneur.2019.01283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an immune-mediated disorder of the central nervous system characterized by an inflammatory response to amyloid-beta (Aβ) deposition within cerebral blood vessel walls. Immunosuppressive therapy is the mainstay of treatment. We present a case of CAA-ri in a subject already on immunosuppressive therapy after orthotopic heart transplantation (OHT). A 57-year-old man 8 months post-OHT for sarcoid cardiomyopathy developed headaches and staring spells while hospitalized for disseminated mycobacterial infection. His brain MRI revealed bi-hemispheric T2-weighted fluid-attenuated inversion recovery white matter hyperintensities and widespread microhemorrhages. Two weeks later, he developed gait ataxia and alterations in mental status, and repeat brain MRI showed more extensive confluent white matter hyperintensities. Leptomeningeal and cortex biopsy revealed changes consistent with amyloid angiitis, with perivascular and intramural histiocyte and lymphocyte collections. Mass spectroscopy confirmed Aβ deposition. Notably, the patient was on immunosuppression with daily 5 mg oral prednisone and tacrolimus before biopsy. After high-dose intravenous followed by oral corticosteroids, he demonstrated significant clinical and radiographic improvement. No relapse was noted despite the relatively rapid tapering of the prednisone therapy over 3 months, as mandated by his systemic infection. Despite the lack of a standard treatment protocol for CAA-ri, case series have reinforced the benefit of prolonged courses of glucocorticoids as single agent or in combination with other immunomodulatory agents. Hence, management of CAA-ri in patients with disseminated mycobacterial infections or OHT is challenging. Our case is unique, as review of existing literature has not revealed any similar cases of patients on chronic immunosuppression at the time of CAA-ri diagnosis, which one would expect to protect against this disorder. In addition, CAA-ri in association with cardiopulmonary sarcoidosis was not previously reported; however, a common immunopathogenic mechanism may exist.
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Affiliation(s)
- Thomas Nelson
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Bo Leung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Serguei Bannykh
- Division of Neuropathology, Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Kevin S Shah
- Division of Heart Transplantation, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jignesh Patel
- Division of Heart Transplantation, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Oana M Dumitrascu
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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