Case report: A rare presentation of cardiac sarcoidosis with recurrent
large pericardial effusion and stress-induced cardiomyopathy
Abstract
A 65-year-old female known to have type 2 diabetes mellitus, with no
significant past medical history, had presented to another hospital with
progressive dyspnea, orthopnea, lower limb edema in the two weeks
preceding the reporting of this case. Her echocardiography revealed
large pericardial effusion with echocardiographic signs of increased
intrapericardial pressure. An emergency pericardiocentesis was
performed. One week afterwards, she was admitted to the authors’
hospital because of re-accumulation of her large pericardial effusion,
which mandated another pericardiocentesis. A CT of the chest revealed
enlarged mediastinal lymph nodes (LNs). Video-assisted thoracic surgery
(VATS) was done to obtain a pericardial window and a biopsy from the
mediastinal LN, which revealed non-caseating granuloma, highly
suggestive of sarcoidosis. A few days after surgery she experienced a
neurogenic bladder, acute renal shutdown, and metabolic acidosis, during
which she developed stress-induced cardiomyopathy that improved a few
days later. The patient’s symptoms improved after receiving
corticosteroids.