Phenotype of Infiltrating T Lymphocytes in Cardiac Sarcoidosis
Apreviously well 29-year-old woman was referred to our hospital after a syncopal attack accompanied by severe congestive heart failure. The ECG showed complete atrioventricular conduction block, which necessitated immediate pacemaker implantation. Echocardiography revealed septal, apical, and lateral hypokinesia with a left ventricular ejection fraction of 23% and a systolic anterior and posterior pericardial effusion of 3 mm. The results of the chest radiograph were normal. Coronary angiography detected no stenotic lesions. The hematoxylin- and eosin-stained sections of a left ventricular endomyocardial biopsy showed noncaseating granulomas with giant cells at onset of disease and 4 months later; 12 months later, biopsies had no granulomas (Figure 1). The patient was diagnosed as having sarcoidosis confined to the heart. Therapy with high-dose methylprednisolone (100 mg daily) and azathioprine (150 mg daily) was initiated after the first biopsy and tapered slowly over months with improvement of clinical findings. Phenotyping of infiltrating T cells before immunosuppressive treatment revealed activation of T cells (coexpression of CD3 and HLA-DR/CD69) as well as CD95/Fas staining; ligation of this molecule is thought to trigger apoptosis of recently activated T cells (Figures 2a through 2c). CD4+ T cells predominated over CD8+ T cells and high numbers of memory (CD4/CD29+) T cells were detected, whereas naive (CD4/CD45RA+) T cells were scarcely scattered in the biopsies (Figures 2d and 2e). Thus, T cells in cardiac sarcoidosis shared high similarity with the phenotype of T cells in bronchoalveolar lavage fluid of patients with pulmonary sarcoidosis.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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