A case of cardiac sarcoidosis mimicking acute phase of takotsubo cardiomyopathy evaluated by multimodality cardiac imaging

The patient was a 68-year-old woman who experienced loss of consciousness owing to a seizure while walking and bruised her face. Twelve‑lead electrocardiography displayed a complete atrioventricular block. Transthoracic echocardiography displayed hypokinesis from the middle to apex of the myocardium. Emergency coronary angiography displayed no clear stenosis of the coronary arteries, and left ventriculography displayed takotsubo-like abnormal left ventricular wall motion. ^99mTc-sestamibi/¹²³I-beta-methyl iodophenyl pentadecanoic acid dual single-photon emission computed tomography displayed a perfusion/metabolism mismatch in the left apex, anterior segment, and inferior segment of the myocardium in the acute phase, which improved in the chronic phase. Similar mismatch findings were observed in the ventricular septum, which persisted in the chronic phase. Blood biomarkers of sarcoidosis were positive. Myocardial delayed enhancement was observed in the mid layer of the basal septum and inferior wall on cardiac magnetic resonance imaging. Fluorodeoxyglucose-positron emission tomography displayed signal accumulation in the basal septum. The clinical course of the patient suggested the possibility of cardiac sarcoidosis combined with takotsubo cardiomyopathy. This is a valuable case in which changes over time were detected by multimodality cardiac imaging.

Learning objective

Cardiac manifestations of both takotsubo cardiomyopathy and sarcoidosis are similar, with both causing abnormal left ventricular wall motion. The co-occurrence of these conditions has been seldomly reported to date. The similarity of the characteristics of each condition poses a challenge in the diagnostic process. The utilization of multimodality cardiac imaging techniques, as demonstrated in the present case, is an effective means of establishing a diagnosis.