Researchers Report Case of Sarcoidosis, Pulmonary Hypertension Patient

Sarcoidosis patients may develop pulmonary hypertension that leads to severe heart complications, according to a study published in the journal Case Reports in Cardiology.

In the study, “Multifactorial Etiology Pulmonary Hypertension In A Patient With Sarcoidosis,” researchers described a case of pulmonary sarcoidosis, heart failure, and pulmonary hypertension (PH) that presented resistance to medical treatment.

Researchers followed a 53-year-old male patient who was referred to the hospital with complaints of dyspnea (shortness of breath) at rest and edema of the legs for one month. His history of dyspnea started 18 years earlier and was felt during moderate to intense effort, which led to the diagnosis of pulmonary sarcoidosis.

An echocardiography exam revealed signs of structural changes in the heart that are consistent with PH diagnosis. In addition, the patient had battled symptoms of severe chronic kidney failure for six years and epilepsy for about 15 years. He was a former smoker and had been exposed to dust in his work place.

The patient’s regular medication included a litany of drugs that included corticosteroids, vasodilators metoprolol, amlodipine and sildenafil. Because the patient reported episodes of hypotension (low blood pressure) he was hospitalized for clinical care.

Further examination showed more heart changes that included mitral valve disease, enlargement of right chambers, and worsening of pulmonary artery pressure. Doctors prescribed daily hemodialysis to improve his symptoms, and increased doses of metoprolol (150 mg/day) and prednisone (40 mg/day). The approaches induced no improvement.

The patient’s health deteriorated further a few days later with drowsiness, rapid breathing, increased heartbeat, cold and clammy skin, weak pulse, and other symptoms. He was transferred to the intensive care unit to receive hemodynamic support with vasoactive drugs, but he did not respond to treatment and died.

According to the authors, heart failure is exacerbated by the presence of PH, but not knowing what caused PH, whether it was mitral valve disease or sarcoidosis, further complicated the case.

“In this case the surgical approach of mitral valve was not possible,” the authors wrote. “The patient did not have favorable valve anatomical conditions to mitral stenosis percutaneous repair and also had high surgical risk (severe pulmonary hypertension and disorders of right ventricle and kidneys) to mitral valve replacement. There was no possibility to carry out more radical therapies like cardiac transplantation because of severe fixed pulmonary hypertension and [other anomalies] because of high mortality inherent to it.”

The presence of heart complications that are impossible to treat raise the question of whether palliative care is the best option for patients in similar situations.

“It is very difficult to determine the time when  patient care should be palliative,” they added. “… prognostic factors were presented in this case and it was featured as terminal [heart failure].”