DILATED CARDIOMYOPATHY AS THE INITIAL PRESENTATION OF CARDIAC SARCOIDOSIS IN A YOUNG PATIENT

Sarcoidosis is a systemic granulomatous disease that most commonly affects the lungs and lymphatic system. Cardiac involvement is uncommon but potentially life-threatening and may present with heart failure, arrhythmias or conduction disorders. Early diagnosis remains challenging due to the lack of specific clinical and biological markers.We report the case of a 21-year-old woman with no significant medical history who presented with dyspnea, palpitations and lower limb edema. Clinical examination revealed signs of right sided heart failure. Electrocardiography showed regular tachycardia and left atrial enlargement. Transthoracic echocardiography demonstrated a severe non-ischemic dilated cardiomyopathy with biventricular dilation and a left ventricular ejection fraction of 20%. Thoracoabdominal computed tomography revealed pulmonary nodules and micronodules suggestive of sarcoidosis. Cardiac magnetic resonance imaging showed transmural and subepicardial late gadolinium enhancement at the right and left ventricular insertion points, supporting the diagnosis of cardiac sarcoidosis. The patient was treated with high-dose corticosteroids and monthly cyclophosphamide pulses, followed by azathioprine maintenance therapy, resulting in significant improvement of left ventricular function.This case highlights the importance of cardiac imaging in the diagnosis and management of cardiac sarcoidosis.