{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:53Z","timestamp":1753876253488,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Sarcoidosis is a systemic inflammatory disease of unknown aetiology characterized by the formation of non-caseating granulomas. Cardiac involvement occurs in up to 30% of cases but only manifests clinically in 5%. In young patients presenting with high-grade atrioventricular block, infiltrative processes such as sarcoidosis should be considered in the differential diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present the case of a 35-year-old male who presented to hospital with symptomatic complete heart block as the first manifestation of multi-system sarcoidosis with cardiac involvement. Initial blood testing, chest x-ray and transthoracic echocardiography were unremarkable, leaving a broad differential to be considered. Cardiac magnetic resonance imaging revealed late gadolinium enhancement in a highly variable and non-coronary distribution, with simultaneous involvement of subepicardial, subendocardial, and midwall tissue. High-resolution computed tomography of the thorax revealed significant intrathoracic lymphadenopathy. Endobronchial ultrasound-guided lymph node sampling and analysis revealed the presence of non-caseating granulomas, providing histological confirmation of the disease. The patient\u2019s clinical course was complicated by the development of ventricular standstill, thus insertion of an implantable cardioverter-defibrillator was carried out. Immunosuppressive therapy with oral prednisolone was commenced prior to discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Cardiac sarcoidosis can produce life-threatening complications if left untreated. Our case serves to highlight the need for consideration of sarcoidosis as a cause for cardiac conduction disease in young patients, and the utility of multimodality imaging in its diagnosis. Cardiac magnetic resonance imaging serves as a useful tool when faced with this clinical picture.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf210","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T12:09:10Z","timestamp":1745669350000},"source":"Crossref","is-referenced-by-count":0,"title":["Complete heart block as the first manifestation of systemic sarcoidosis: a case report highlighting the diagnostic utility of multimodality imaging"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4309-2811","authenticated-orcid":false,"given":"Ryan","family":"Karlsson","sequence":"first","affiliation":[{"name":"Department of General Medicine, Midland Regional Hospital Tullamore , Offaly R35 NY51 ,","place":["Ireland"]},{"name":"Department of Cardiology, St James\u2019s Hospital , James St, Dublin D08 NHY1 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niall","family":"O\u2019Rourke","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Midland Regional Hospital Tullamore , Offaly R35 NY51 ,","place":["Ireland"]},{"name":"Department of Cardiology, St James\u2019s Hospital , James St, Dublin D08 NHY1 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chithra","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Midland Regional Hospital Tullamore , Offaly R35 NY51 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St James\u2019s Hospital , James St, Dublin D08 NHY1 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Midland Regional Hospital Tullamore , Offaly R35 NY51 ,","place":["Ireland"]},{"name":"Department of Cardiology, St James\u2019s Hospital , James St, Dublin D08 NHY1 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"2025050707510881100_ytaf210-B1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.31083\/j.rcm2502037","article-title":"Cardiac sarcoidosis: a comprehensive clinical review","volume":"25","author":"Vereckei","year":"2024","journal-title":"Rev Cardiovasc Med"},{"key":"2025050707510881100_ytaf210-B2","doi-asserted-by":"crossref","first-page":"100936","DOI":"10.1016\/j.cpcardiol.2021.100936","article-title":"Cardiac sarcoidosis: a clinical overview","volume":"46","author":"Alba","year":"2021","journal-title":"Curr Probl Cardiol"},{"key":"2025050707510881100_ytaf210-B3","doi-asserted-by":"crossref","first-page":"546","DOI":"10.5114\/aoms.2011.24118","article-title":"Cardiac sarcoidosis: a comprehensive review","volume":"7","author":"Sekhri","year":"2011","journal-title":"Arch Med Sci"},{"key":"2025050707510881100_ytaf210-B4","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1136\/bmj.2.5366.1149","article-title":"The aetiology of complete heart-block","volume":"2","author":"Zoob","year":"1963","journal-title":"Br Med J"},{"key":"2025050707510881100_ytaf210-B5","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.ihj.2021.09.013","article-title":"Etiology of chronic atrioventricular block in young adults in a public university hospital in India","volume":"73","author":"Chavan","year":"2021","journal-title":"Indian Heart J"},{"key":"2025050707510881100_ytaf210-B6","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.hrthm.2014.03.043","article-title":"HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis","volume":"11","author":"Birnie","year":"2014","journal-title":"Heart Rhythm"},{"key":"2025050707510881100_ytaf210-B7","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1093\/ehjci\/jex146","article-title":"A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology","volume":"18","author":"Writing group; Document reading group; EACVI Reviewers: This document was reviewed by members of the EACVI Scientific Documents Committee for 2014\u20132016 and 2016\u20132018","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025050707510881100_ytaf210-B8","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC Guidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur Heart J"},{"key":"2025050707510881100_ytaf210-B9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.jcmg.2022.10.018","article-title":"Prognostic value of late gadolinium enhancement detected on cardiac magnetic resonance in cardiac sarcoidosis","volume":"16","author":"Stevenson","year":"2023","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf210\/63025155\/ytaf210.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/5\/ytaf210\/63025155\/ytaf210.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/5\/ytaf210\/63025155\/ytaf210.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T11:51:16Z","timestamp":1746618676000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf210\/8121488"}},"subtitle":[],"editor":[{"given":"Patrick","family":"Badertscher","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Boldizsar","family":"Kovacs","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Felix","family":"G\u00f6tzinger","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Teodor","family":"Serban","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Piera","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf210","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,4,29]]},"article-number":"ytaf210"}}