Myocardial Sarcoidosis Unresponsive to SteroidsTreatment with Cyclophosphamide
Corticosteroids are the mainstay in the treatment of chronic sarcoidosis. Only recently have immune-alter-ing medications been used, usually in patients who have been shown to have disease unresponsive to steroid therapy. The following case exemplifies this unusual aspect of sarcoidosis.
Case Report
A 37-year-old black woman presented in January, 1979 with shortness of breath and bilateral hilar lymphodenopathy. Sarcoidosis was diagnosed by mediastinoscopy and biopsy. Prednisone was prescribed, but she discontinued its use after two months due to Cushingoid side effects. In August, 1979, she presented with a massive left pleural efiusion. An exhaustive workup revealed only sarcoidosis. Prednisone was started at 30 mg per day. The pleural efiusion initially resolved but gradually recurred. After eight months of steroid treatment consisting of at least 30 mg/day, a massive left and small right pleural efiusion were seen on the chest x-ray film. Cardiomegaly was also seen and an echocardiogram demonstrated gross pericardial efiusion. Therapy with high-dose prednisone (60-100 mg/day) was associated with an immediate reduction in the pleural and pericardial effusions. These findings later recurred and by August, 1980, the physical examination revealed anasarca. (more…)