Recurrent Syncope Due to Concurrent Cardiac Sarcoidosis and Large-Vessel Vasculitis

Patient: Male, 68-year-old Final Diagnosis: Sarcoidosis • vasculitis Symptoms: Syncope Medication:— Clinical Procedure: — Specialty: Rheumatology OBJECTIVE: Rare co-existance of disease or pathology BACKGROUND: Cardiac sarcoidosis and large-vessel vasculitis are both rare diseases with a variety of presenting symptoms. Both can result in high morbidity and mortality if not diagnosed early. While they are each relatively uncommon on their own, there have been a few reports suggesting they may be more related than previously thought. This case report suggests that the 2 diseases can become symptomatic concurrently, complicating diagnosis. CASE REPORT: A 68-year-old male patient was diagnosed concurrently with cardiac sarcoidosis and vasculitis after several episodes of syncope thought to be due to arrhythmia. The patient was treated with high-dose corticosteroids, and repeat imaging showed decreased inflammatory changes in the cardiac tissue and large blood vessels. CONCLUSIONS: Prior case reports have described vasculitis and sarcoidosis in the same patient; however, these patients usually had a long history of known sarcoidosis involving several organ systems. This case suggests that physicians should be alert to more limited forms of the disease in a patient with cardiac myopathy of unknown origin with new arrythmia. More research is also needed to determine how granulomatous disease and vasculitis are related to each other.