METASTATIC CARDIAC CALCIFICATION OF UNCLEAR ETIOLOGY - SARCOIDOSIS OR MASQUERADER?

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

calcium, gadolinium, prednisone, adult, amyloidosis, bronchoscopy, calcinosis, calcium balance, calcium homeostasis, cardiac sarcoidosis, cardiovascular magnetic resonance, case report, clinical article, complete heart block, conference abstract, diagnosis, drug therapy, end stage renal disease, etiology, heart arrhythmia, heart calcification, heart muscle biopsy, heart muscle injury, heart ventricle tachycardia, human, human tissue, image enhancement, immunoglobulin A nephropathy, immunosuppressive treatment, intravenous drug administration, lymphadenopathy, male, metastasis, middle aged, MRI scanner, myocarditis, nonischemic cardiomyopathy, nuclear magnetic resonance imaging, paroxysmal supraventricular tachycardia, positron emission tomography-computed tomography, sarcoidosis, therapy

Abstract

Background: Myocardial calcification typically occurs in the setting of previous myocardial injury, although abnormal calcium homeostasis and some systemic diseases can lead to calcium deposition. Understanding disease patterns is important to guide management in undifferentiated patients. Case 40-year-old male with a history significant for ESRD on HD secondary to IgA nephropathy was found to have nonischemic cardiomyopathy with reduced ejection fraction, refractory VT, and complete heart block. CT chest showed mediastinal adenopathy and opacities. Multiple bronchoscopies were negative for malignancy/granulomas. Cardiac MRI demonstrated abnormal signal on delayed gadolinium enhancement images involving the basal to mid left ventricle. PET CT showed moderate intensity signal involving basal/mid anterior, lateral, septal, and inferior walls in the setting of normal perfusion concerning for sarcoidosis. Endomyocardial biopsy showed normal myocardium and was negative for amyloid. He was managed for sarcoidosis due to multiorgan involvement consistent with the disease. He was treated with Prednisone but unfortunately had recurrent admission for ventricular tachycardia. He was recommended to pursue comfort care. Decision-making It is believed that he had myocardial calciphylaxis leading to inflammation of the myocardium as the active areas on PET correlated with the areas of calcium deposition on CT and MRI. Other etiologies for such a presentation include sarcoidosis or amyloidosis however he had an extensive workup that showed no other signs of sarcoid or amyloid (1). He was managed empirically for cardiac sarcoidosis with a trial of steroids and was started on a phosphate binder to help with calcium balance. He continues to have issues with arrythmias and is being managed medically as he is not a candidate for more advanced therapies. Conclusion While this patient was managed empirically for cardiac sarcoidosis, his disease continued to be uncontrolled on traditional immunosuppression. A second opinion at another academic center was also unrevealing. Understanding the spectrum of disease that can occur with sarcoidosis is important to guide decisions based on therapy.

Volume

85

Issue

12

First Page

4130

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