Reversible Right Ventricular Hypertrophy Due to Cardiac Sarcoidosis
A 42-year-old man was admitted to our hospital with shortness of breath on light effort. An ECG revealed advanced AV block (Figure 1A), and a chest CT scan showed markedly increased thickness (12 mm) of the right ventricular wall (Figure 2A). The endomyocardial biopsy showed a noncaseous epithelioid cell granuloma with giant cells, which supported the diagnosis of cardiac sarcoidosis (Figure 3). There was no evidence of systemic inflammation, such as fever, elevated C-reactive protein, leukocytosis, or eosinophilia. Treatment with oral prednisolone (40 mg daily) was started, and the “hypertrophy” of the right ventricular wall disappeared (wall thickness 6 mm) and AV conduction normalized within 2 months (Figures 1B and 2⇓B). This reversible right ventricular hypertrophy was also confirmed by serial echocardiography. Because of the reversible nature, the right ventricular hypertrophy was considered to reflect myocardial cell infiltration or edema. No recurrence has been detected in the subsequent 2 years with a reduced dose of prednisolone (10 mg/d).