Bidirectional Ventricular Tachycardia in a Patient With Fulminant Myocarditis Secondary to Cardiac Sarcoidosis Mimicking Giant Cell MyocarditisNovel Teaching Points
Daniel Durocher, MD,
Imane El-Hajjaji, MBBS,
Syed O. Gilani, MD,
Peter Leong-Sit, MD, MSc,
Ryan A. Davey, MD,
Sabe K. De, MD
Affiliations
Daniel Durocher, MD
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Imane El-Hajjaji, MBBS
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Syed O. Gilani, MD
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Peter Leong-Sit, MD, MSc
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Ryan A. Davey, MD
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Sabe K. De, MD
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Corresponding author: Dr Sabe K. De, Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd, London, Ontario N6A 5A5, Canada. Tel.: +1-519-663-3428; fax: +1-519-663-3764.
Differentiating between sarcoidosis and giant cell myocarditis (GCM) based on clinical presentation is difficult. We present the case of a 57-year-old woman who was initially diagnosed with GCM based on endomyocardial biopsy. The patient was refractory to standard management for GCM and went on to develop bidirectional ventricular tachycardia, a finding suggestive of sarcoidosis. Unfortunately, the patient eventually needed cardiac transplantation. The explanted heart demonstrated cardiac sarcoidosis. Bidirectional ventricular tachycardia has not been demonstrated in GCM, and its presence may help in distinguishing between GCM and cardiac sarcoidosis. Résumé: La distinction entre la sarcoïdose et la myocardite à cellules géantes (MCG) fondée sur le tableau clinique est difficile. Nous présentons le cas d’une femme de 57 ans qui avait initialement reçu un diagnostic de MCG à la suite de la biopsie endomyocardique. Comme la MCG diagnostiquée chez la patiente était réfractaire à la prise en charge thérapeutique habituelle, elle a continué à souffrir de tachycardie ventriculaire bidirectionnelle, un signe évocateur de sarcoïdose. Malheureusement, la patiente a finalement eu besoin d’une transplantation cardiaque. Le cœur explanté a démontré une sarcoïdose cardiaque. Bien que la tachycardie ventriculaire bidirectionnelle n’ait pas été démontrée lors de MCG, sa présence peut aider à distinguer la MCG de la sarcoïdose cardiaque.
