Cardiac sarcoid (sarcoidosis)

General: May present with restrictive or dilated cardiomyopathy, congestive heart failure, ventricular dysrhythmias, heart block, or pericarditis. Of patients with sarcoidosis, <5% have cardiac symptoms while only half of patients with cardiac sarcoid seen at autopsy or transplant had already been diagnosed. However, ~25% of patients with sarcoidosis have cardiac involvement at autopsy. It is slowly progressive, and may recur post-transplant.

Gross:

Microscopic: Patchy myocardial involvement by well-formed granulomatous inflammation, myocyte necrosis, and fibrosis, with negative stains for organisms. May have numerous giant cells and extensive fibrosis. May also involve the epicardial surface or fat, in contrast to some similar lesions.

Differential Diagnosis:

• Myocardial infection
• Giant cell myocarditis
• Cardiac amyloid
• Chagas disease
• Fabry disease
• Remote myocardial infarction

Stains:

• Positive:
• Negative: GMS, AFB
• Suggested, focused panel:

(Lefkowitch: AP Board Review)

Images:


Cases:

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