Cardiac Sarcoidosis Presenting as Aborted Sudden Death

A 42 year old lady with a diagnosis of hyperreactive airway disease since 4 years, treated with bronchodilators presented with monomorphic ventricular tachycardia with syncope requiring direct current (DC) cardioversion. 2 dimensional echocardiography with cardiac colour doppler examination and magnetic resonance Imaging (MRI) revealed left ventricular dilatation, systolic dysfunction with patchy areas of thickening and regional wall motion abnormality not specific to any particular vascular territory and advanced diastolic dysfunction.

Review of records revealed persistently raised erythrocyte sedimentation rate which was previously ignored.

Gadolinium contrast cardiac MRI revealed late gadolinium enhancement suggestive of myocarditis. Thoracic MRI revealed a mediastinal lymphnode mass. A computed tomography (C.T.) directed lymphnode biopsy confirmed Sarcoidosis. She was offered implantable cardioverter-defibrillator device and immunosuppression therapy with prednisolone 1 mg/kg/day.