University of South Florida PM&R Tampa, Florida, United States
Case Diagnosis: Patient diagnosed with sarcoid cardiomyopathy, complicated by heart failure with reduced ejection fraction from 41% to 15–20%.The sarcoid-related myocardial infiltration by granulomatous inflammation and subsequent fibrotic replacement manifested as dyspnea, lower extremity edema, and orthostatic hypotension. PFTs demonstrated a restrictive ventilatory defect with reduced DLCO representing interstitial lung disease. He eventually developed sarcoid-related peripheral neuropathy and anterior uveitis. These complications were closely monitored during patient's rehab stay.
Case Description: A 57-year-old male veteran with sarcoid cardiomyopathy s/p AICD (2010), pulmonary fibrosis, OSA, substance use disorders, T2D, HTN, and HLD presented with progressive dyspnea, edema, orthopnea, and abdominal distension. Recently unhoused after job loss, he was noncompliant with medications (hydroxychloroquine, carvedilol, torsemide) and escalated alcohol/cocaine use. He reported 10-pound weight loss from poor appetite and early satiety. Following a complicated hospital course, he developed severe deconditioning and entered acute inpatient rehabilitation. During therapies, he battled sarcoidosis-related complications including anterior uveitis, skin nodules, cough, neuropathy, and hypotension.
Discussions: During AIR, high-dose corticosteroid therapy was continued to suppress granulomatous activity, with gradual tapering guided by clinical response and pulmonary imaging. To minimize steroid-related side effects, methotrexate was introduced, necessitating close monitoring of liver function and blood counts. His worsening cardiomyopathy was managed with beta-blockers, ACE inhibitors, and diuretics. Pulmonary rehab included oxygen and inspiratory training. Gabapentin addressed neuropathic pain, and corticosteroid eye drops treated uveitis, stabilizing his disease and maximizing rehab outcomes.
Conclusions: Recognizing and managing sarcoidosis flares early in rehabilitation is key to preventing setbacks. A comprehensive approach that includes medical care, cardiopulmonary exercise, cognitive training, and psychosocial support can improve recovery and help lower the risk of hospital readmission in patients with advanced cardiac sarcoidosis
