Cardiac sarcoidosis: a case report

Sarcoidosis is a granulomatous disease of unknown etiology, which can affect people of all racial and ethnic groups and can occur at all ages. Currently, sarcoidosis is considered as a worldwide disease with different prevalence rates. Arrhythmias are the leading cause of sudden death among patients diagnosed with cardiac sarcoidosis. In this case, the deceased was a 51-year-old male, a foreigner, with a history of type II diabetes and hypertension and was on treatment for 12 years. He was found unresponsive in a chair at his residence by his son. Autopsy revealed an enlarged heart (heart weight 543 g, 95th percentile for height is 387 g; 95th percentile for weight is 474 g). The pericardial sac is intact. There are no adhesions and no collections of fluid or blood. Epicardium was unremarkable. No acute ischaemic changes were seen in the myocardium. The coronary arteries were normal in configuration with a right dominant circulation. Histopathology of all organs were performed. Sections of myocardium showed varying degrees of replacement fibrosis with an inflammatory infiltrate comprising epithelioid histiocytes, giant cells and occasional non-necrotizing granulomata. There were no acute ischaemic changes. Toxicology screening was negative for common poisons and substance of abuse. These findings were in keeping with cardiac sarcoidosis and concluded it as cause of death. This was a rare case of sarcoidosis where the diagnosis was made with the aid of thorough histopathology examination. The importance of a thorough knowledge on specific cardiac conditions that can cause sudden death is highlighted here.