心室頻拍にメチルプレドニゾロン・パルス療法が奏功した心サルコイドーシスの1例

Abstract

A 63-year old woman was admitted because of ventricular tachycardia and congestive heart failure. A chest radiograph showed cardiomegaly and bilateral hilar lymphadenopathy. Echocardiogram showed diffuse left ventricular hypokinesis, dilated left ventricle and thinning of the interventricular septum. On gallium scintigram gallium was accumulated in the heart, especially in the left ventricle. Although endomyocardial biopsy revealed non-specific fibrosis, cardiac sarcoidosis was clinically suspected. On the 10th day of the addmission, multiple episodes of sustained ventricular tachycardia appeared. As it was refractory to lidocaine infusion, methylpredonisolone pulse therapy was initiated, which abated ventricular tachycardia. Corticosteroid was gradually tapered off and ventricular tachycardia never recurred. Methylpredonisolone pulse therapy could be a therapeutic option for cardiac sarcoidosis with fatal arrhythmia even if histological evi- dence of cardiac sarcoidosis is absent.