Remission of Cardiac Sarcoidosis after the Administration of Methotrexate as First-line Drug Therapy

Hirochika Yamasaki; Hidekazu Kondo; Naoko Ogawa; Kazuki Mitarai; Yumi Ishi; Shotaro Saito; Naohiko Takahashi

doi:10.2169/internalmedicine.2759-23

Remission of Cardiac Sarcoidosis after the Administration of Methotrexate as First-line Drug Therapy

Intern Med. 2023 Dec 18. doi: 10.2169/internalmedicine.2759-23. Online ahead of print.

Authors

Hirochika Yamasaki¹, Hidekazu Kondo¹, Naoko Ogawa¹, Kazuki Mitarai¹, Yumi Ishi¹, Shotaro Saito¹, Naohiko Takahashi¹

Affiliation

¹ Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan.

PMID: 38104992
DOI: 10.2169/internalmedicine.2759-23

Abstract

A 54-year-old woman developed new-onset heart failure and was diagnosed with cardiac sarcoidosis. An implantable cardioverter-defibrillator with biventricular pacing was implanted before immunosuppressive therapy to prevent sudden death. The patient refused oral steroids because she disliked their specific side effects and potential adverse events with long-term use; therefore, methotrexate was chosen as an alternative first-line drug. Nine months after starting oral therapy, ¹⁸F-fluorodeoxyglucose-positron emission tomography revealed remission of sarcoidosis, disappearance of heart failure symptoms, marked improvement in cardiac contractility, and a reduced frequency of ventricular arrhythmias.

Keywords: 18F-fluorodeoxyglucose positron emission tomography; cardiac sarcoidosis; corticosteroids; methotrexate.