Figure 4.

Cardiac sarcoidosis and inflammation: case presentation. A 55-year-old man with history of inflammatory polyarthritis presented to our hospital for palpitation and presyncopal events. A: An initial 12-lead electrocardiogram upon arriving at emergency department showed monomorphic ventricular tachycardia at 214 beats/min. B: A repeated 12-lead electrocardiogram postcardioversion showed junctional rhythm and ectopic atrial rhythm with prolonged PR of 400 ms and right bundle branch block. C and D: Cardiac magnetic resonance showed diffuse late gadolinium enhancement in the right ventricular (RV) free wall (white arrow) and left ventricular (LV) basal to mid inferoseptal (white star), anteroseptal (white arrowhead), and inferolateral (asterisk) walls, and LV ejection fraction of 37% and RV ejection fraction of 38%. This patient has a classic hook or hug sign of late gadolinium enhancement involving ventricular insertions across the septum into the RV on cardiac magnetic resonance. E and F:¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography scan showed diffuse ¹⁸F-fluorodeoxyglucose uptake on the LV septum, basal anterior and inferior, and on RV free wall. G and H: Histological specimen from the RV myocardium of the patient showed diffuse lymphoplasmacytic infiltrate (white arrow) with Langhans multinucleated giant cell (white star) and non-necrotizing granulomas (asterisk).