Sarcoidosis of the cardio-pulmonary systems

Neurosarcoidosis in a 67-Year-Old Male Without Pulmonary Involvement: A Case Report

Neurosarcoidosis is a rare and complex form of sarcoidosis that affects the nervous system, presenting significant diagnostic and therapeutic challenges due to its varied neurological symptoms and potential complications. We present a case of a 67-year-old immunocompetent male who presented with altered sensorium, prompting a thorough evaluation. His medical history revealed intermittent low-grade fevers, progressive weight loss, and frailty, rendering him bedridden for over a year. Previous blood tests had ruled out specific etiologies, with normal serum calcium and angiotensin-converting enzyme (ACE) levels. Upon presentation, further diagnostic workup included imaging and laboratory tests. Results showed elevated serum calcium, increased ACE levels, and depressed intact parathyroid hormone levels. MRI of the brain with contrast revealed lobulated mucosal thickening in the right sphenoid sinus and adjacent anterior cavernous sinus. A CT scan of the chest was unremarkable. Additionally, a splenic biopsy revealed hypoechoic foci with neutrophilic, lymphocytic, and histiocytic granulomas. Based on imaging and histopathological findings, the patient was diagnosed with neurosarcoidosis. The patient was treated with prednisolone and methotrexate, leading to a prompt improvement in consciousness and symptoms. Follow-up demonstrated continued improvement and stabilization of his condition. This case highlights the importance of considering neurosarcoidosis in patients with unexplained neurological symptoms and underscores the value of a multidisciplinary approach in managing this challenging condition.

Catheter ablation for ventricular tachycardia in patients with cardiac sarcoidosis: a systematic review

Aims

Cardiac sarcoidosis (CS) is associated with a poor prognosis. Important features of CS include heart failure, conduction abnormalities, and ventricular arrhythmias. Ventricular tachycardia (VT) is often refractory to antiarrhythmic drugs (AAD) and immunosuppression. Catheter ablation has emerged as a treatment option for recurrent VT. However, data on the efficacy and outcomes of VT ablation in this context are sparse.

Methods and results

A systematic search was performed on PubMed, EMBASE, and Cochrane database (from inception to September 2016) with included studies providing a minimum of information on CS patients undergoing VT ablation: age, gender, VT cycle length, CS diagnosis criteria, and baseline medications. Five studies reporting on 83 patients were identified. The mean age of patients was 50 ± 8 years, 53/30 (males/females) with a maximum of 56 patients receiving immunosuppressive therapy, mean ejection fraction was 39.1 ± 3.1% and 94% had an implantable cardioverter defibrillator in situ. The median number of VTs was 3 (2.6-4.9)/patient, mean cycle length of 360 ms (326-400 ms). Hundred percent of VTs received endocardial ablation, and 18% required epicardial ablation. The complication rates were 4.7-6.3%. Relapse occurred in 45 (54.2%) patients with an incidence of relapse 0.33 (95% confidence interval 0.108-0.551, P < 0.004). Employing a less stringent endpoint (i.e. freedom from arrhythmia or reduction of ventricular arrhythmia burden), 61 (88.4%) patients improved following ablation.

Conclusions

These data support the utilization of catheter ablation in selected CS cases resistant to medical treatment. However, data are derived from observational non-controlled case series, with low-methodological quality. Therefore, future well-designed, randomized controlled trials, or large-scale registries are required.