Summary
A 49-year-old man with cardiac sarcoidosis is presented. He suffered from congestive heart failure, and left ventricular asynergy and reduced function was evident by echocardiogram and left ventriculogram. A light microscopic examination of the endomyocardial biopsy revealed nonspecific myocarditis without giant cells or noncaseating granulomas. Under an electron microscope, however, several epithelioid cells were found in the specimen. The serum level of lysozyme was elevated. The patient had a past history of sarcoidosis of the eyes and lungs 22 years previously. Cardiac diseases presenting epithelioid cells other than sarcoidosis were clinically ruled out. Thus, the diagnosis of cardic sarcoidosis was made based on both clinical and ultrastructural findings, and corticosteroid therapy was initiated. In the second biopsy, performed 4 months later, a noncaseating granuloma was found. Generally, the incidence of histological diagnosis of cardiac sarcoidosis by light microscopy is relatively low in endomyocardial biopsy specimens. The present case suggests that the addition of an ultrastructural examination may improve the diagnostic usefulness of the endomyocardial biopsy in cardiac sarcoidosis, since electron microscopy can clearly identify the presence of even one epithelioid cell.
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Lie JT, Hunt D, Valentine PA (1974) Sudden death from cardiac sarcoidosis with involvement of conduction system. Am J Med Sci 267:123–128
Lull RJ, Dunn BE, Gregoratos G, Cox WA, Fisher GW (1972) Ventricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia. Am J Cardiol 30:282–287
Sekiguchi M, Numao Y, Imai M, Furuie T, Mikami R (1980) Clinical and histological profile of sarcoidosis of the heart and acute idiopathic myocarditis. I. Sarcoidosis. Jpn Circ J 44:249–263
Ratner SJ, Fenoglio JJ Jr, Ursell PC (1986) Utility of endomyocardial biopsy in the diagnosis of cardiac sarcoidosis. Chest 90:528–533
Uemura A, Morimoto S, Hiramitsu S, Yamada K, Kubo N, Kimura K, Ohtsuki S, Terasawa M, Shimizu K, Watanabe Y, Hishida H, Yoshida Y, Itoh A (1994) Incidence of histological diagnosis of cardiac sarcoidosis in the endomyocardial biopsy (in Japanese). J Cardiol 24 [Suppl 40]:75
Fanburg BC (1983) Sarcoidosis and other granulomatous diseases. Marcel Dekker, New York
Child JS, Perloff JK (1988) The restrictive cardiomyopathies. Cardiol Clin 6:289–316
Ishikawa T, Kondoh H, Nakagawa S, Koiwaya Y, Tanaka K (1984) Steroid therapy in cardiac sarcoidosis: Increased left ventricular contractility concomitant with electrocardiographic improvement after predonisolone. Chest 85:445–447
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Takemura, G., Takatsu, Y., Ono, K. et al. Usefulness of electron microscopy in the diagnosis of cardiac sarcoidosis. Heart Vessels 10, 275–278 (1995). https://doi.org/10.1007/BF01744907
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DOI: https://doi.org/10.1007/BF01744907