Untreated cardiac sarcoidosis with active inflammation: Severe left ventricular dysfunction and ventricular wall thinning in three years.

A 74-year-old female was admitted for the treatment of complete atrioventricular block. Echocardiography showed thickening of interventricular septum and a slight thinning in the basal region with normal left ventricular (LV) function. She was clinically diagnosed with cardiac sarcoidosis accompanied by active inflammation from the findings of blood test, nuclear scanning, and magnetic resonance imaging. After pacemaker implantation, we recommended corticosteroid therapy, which she refused for the fear of side effects. Three years later, she was re-admitted to our hospital due to heart failure. Echocardiography showed severe LV systolic dysfunction and dilatation with wall thinning. Even though we started corticosteroid therapy and continued it for one year, LV function was not improved. In patients with cardiac sarcoidosis accompanied by active inflammation, LV dysfunction, and dilatation may rapidly progress. Early diagnosis and treatment with corticosteroid may be important to preserve cardiac function. <Learning objective: Left ventricular (LV) dysfunction in patients with cardiac sarcoidosis accompanied by active inflammation may rapidly progress in a short period. Corticosteroid therapy is demonstrated to improve the long-term clinical outcome, however, it may not be effective once LV function is worsened with wall thinning. Early diagnosis and treatment with corticosteroid may be important to preserve cardiac function in patients with cardiac sarcoidosis accompanied by active inflammation.>.