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Megan L. Krause, Leslie T. Cooper, Panithaya Chareonthaitawee, Shreyasee Amin, Successful use of rituximab in refractory cardiac sarcoidosis, Rheumatology, Volume 55, Issue 1, January 2016, Pages 189–191, https://doi.org/10.1093/rheumatology/kev309
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Sir, We report, to our knowledge, the first use of rituximab for management of refractory cardiac sarcoidosis in a 52-year-old woman with symptoms of progressive heart failure and life-threatening arrhythmia. She initially presented at age 47 years with parotid gland enlargement followed by renal insufficiency 1 year later, both consistent with sarcoidosis on biopsies. She was treated with tapering doses of prednisone. Two years after her initial symptoms, she suffered an out-of-hospital cardiac arrest. She was successfully resuscitated and an endomyocardial biopsy was consistent with sarcoidosis in the setting of a normal coronary angiogram. An implantable cardioverter defibrillator was placed in the left anterior chest with right atrial and ventricular leads. She had progressive symptoms of heart failure, requiring intermittent hospitalizations, and recurrent episodes of ventricular tachycardia, requiring implantable cardioverter defibrillator firings. Her symptoms progressed despite prednisone and trials of steroid-sparing medications, including MMF, AZA, infliximab, MTX and LEF. Her clinical deterioration was corroborated by cardiac PET, using a high-fat, low-carbohydrate patient preparation to suppress myocardial uptake of F-18 fluorodeoxyglucose (F-18 FDG) (sarcoidosis protocol) [1].
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