New Onset Neurosarcoidosis Following Heart Transplant for Cardiac Sarcoidosis (JACC Case Reports June 2024)-Article: New Onset Neurosarcoidosis Following Heart Transplant for Cardiac Sarcoidosis

Article: New Onset Neurosarcoidosis Following Heart Transplant for Cardiac Sarcoidosis

Pdf Summary

A 63-year-old woman who had a heart transplant for cardiac sarcoidosis developed new symptoms of headache, vision changes, vomiting, diarrhea, and cold intolerance. Further evaluation confirmed a diagnosis of neurosarcoidosis, which was treated with steroids and infliximab. Despite no known extracardiac sarcoidosis manifestations at initial diagnosis, the patient experienced complications post-transplant, including mycophenolate toxicity and new atrial flutter. The patient's condition deteriorated, leading to septic shock from ascending cholangitis, and ultimately, she passed away. The case highlights challenges in managing sarcoidosis recurrence post-transplant and the need for optimal surveillance methods. Neurosarcoidosis is rare but associated with increased mortality. Treatment typically involves glucocorticoids, and additional immunosuppressive agents may be added for refractory cases. Surveillance using cardiac MRI and PET scans post-transplant has been suggested. Recurrence of sarcoidosis post-transplant occurs in a small percentage of cases, with risk factors and optimal management strategies yet to be determined. More research is needed on pre-transplant evaluation, monitoring, and immunosuppression protocols for patients with cardiac sarcoidosis undergoing heart transplants to improve outcomes and balance the risks of rejection, recurrence, and infection.

Keywords

heart transplant

cardiac sarcoidosis

neurosarcoidosis

steroids

infliximab

mycophenolate toxicity

atrial flutter

septic shock

ascending cholangitis

cardiac MRI