PO98 - ASYMPTOMATIC HEART AND OCULAR INVOLVEMENT IN MULTIORGAN SARCOIDOSIS IN 34-YEAR-OLD PATIENT
Dubaniewicz Anna (Poland)1; Żegleń Sławomir (Poland)2; Oskar Okuniewski (Poland)3; Jankowska Hanna (Poland)4; Panasik Agnieszka (Poland)1; Skotarczak Monika (Poland)5;
1 - Medical University of Gdansk, the Department of Pulmonology; 2 - Department of Pulmonology, Medical University of Gdansk, Poland ; 3 - Collegium Medicum UMK, Poland; 4 - Medical University of Gdansk, the Department and Chair of Cardiac Disease Diagnostics; 5 - Medical University of Gdansk, the Department of Radiology;
Keywords: asymptomatic sarcoidosis; Cardiac sarcoidosis; Ocular sarcoidosis;
Select the theme: Challenges in Sarcoidosis Diagnosis and Staging
Type: Clinical Cases
Presentation: Poster Presentation

Introduction: In sarcoidosis (SA) lungs and lymphatic system are the most commonly involved. However, SA can develop in threatening vital organs, being asymptomatic in 50-80%. Hence, we present a case report of multiorgan SA with asymptomatic pulmonary, heart and ocular involvement. 

Clinical Case Description: The 34 years-old man with sarcoidosis in an enlarged inguinal lymph node was admitted to the Outpatient Pulmonary Clinic due to assess the extent of disease. PPD and IGRA tests were negative. Blood and urine laboratory test results were normal. HRCT revealed Stage II of SA, which was confirmed by bronchial biopsy. Abdomen ultrasound revealed enlarged liver and spleen with normal echogenicity. The results of static and 24-hour Holter ECG showed no abnormalities. Echocardiography disclosed enlarged left atrium and thickened free wall of left ventricule with ejection fraction of 55%. Cardiac magnetic resonance with gadolinium confirmed cardiac sarcoidosis (CS) and revealed enlarged left ventricle with hypokinesis of apical lateral and inferolateral, middle lower and middle lower-lateral segments with delayed enhancement after gadolinium (LGE). Since LGE only indicates myocyte damage but does not show CS activity, cPET was performed. This study demonstrated active CS. An ophthalmologic evaluation revealed discolored lesions in both eyes. In a fluorescein angiography presented hyperfluorescence and in optical coherence tomography disclosed their tuberous character and their presence in choroid. We decided against biopsy based on the revised IWOS criteria, and the ocular SA was diagnosed. 60 mg of prednisone per day was started with a gradual dose reduction. After 16 months of therapy, remission of changes in the lungs, heart, choroid and lymph nodes was observed. The patient stays under constant care of the Outpatient Pulmonology, Ophthalmology and Cardiology Clinics without relapses. 

Conclusions: Due to the frequent occurrence of asymptomatic SA in life-threatening organs, the diagnostic algorithm should be used in each form of pulmonary and extrapulmonary SA.

Cardiac sarcoidosis in CMR and cPETSarcoidosis -posterior uveitis