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The Korean Journal of Pathology 2001;35(1): 71-75.
Cardiac Sarcoidosis Treated by Cardiac Transplantation: A Case Report.
Jaejung Jang, Kwangseon Min, Gyeong cheon Jung, Jaejung Kim, Inchul Lee
1Departments of Diagnostic Pathology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 138-736, Korea. iclee@www.amc.seoul.kr
2Departments of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 138-736, Korea.
Sarcoidosis, in general, has a low mortality rate. But cardiac sarcoidosis (CS) is a serious condition which may lead to death. Here, we report a rare case of CS that was treated by heart transplantation. A 47-year-old male had occasional syncopes and atypical chest pain. Ventricular tachycardia with right bundle branch block was noted by electrocardiogram. Multiple fixed myocardial perfusion defects in the interventricular septum and both the inferior-posterior ventricular walls were observed by thallium scan. Coronary angiography was unremarkable. Neither perihilar nor mediastinal lymphadenopathy was noted. The patient also suffered three times from tonic-clonic generalized seizures in 3 years, but no neurologic abnormalities were detected. The explanted heart displayed multiple white patches on the endomyocardial surface, measuring up to 8x7 cm. On microscopic examination, the lesion consisted of multiple well-formed and confluent granulomas with numerous scattered multinucleated giant cells, CD68-positive epithelioid histiocytes, and T-lymphocytes. Neither microorganisms nor foreign material was identified on special stain and culture study. It has been six months since the heart transplant, and the patient has been doing well.
Key Words: Cardiac sarcoidosis; Granuloma; Heart transplantation