When Ventricular Tachycardia Hides a Deeper Cause: A Case of Cardiac Sarcoidosis

Cardiac sarcoidosis (CS) is a rare but potentially life-threatening manifestation of sarcoidosis, affecting around 5% of all sarcoidosis patients. We report a 71-year-old male who presented with monomorphic ventricular tachycardia refractory to amiodarone, requiring cardioversion. Echocardiography revealed a basal septal scar and severe mitral regurgitation, while fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated focal myocardial uptake with pulmonary and nodal involvement. Cervical lymph node biopsy confirmed granulomatous inflammation. The patient was treated with corticosteroids and methotrexate and subsequently underwent dual-chamber automatic implantable cardioverter defibrillator (AICD) implantation. Though sarcoidosis is not a common diagnosis in the emergency department, emergency physicians should consider it in patients with atypical arrhythmias or systemic features. This case underscores the diagnostic challenges of CS, which often mimics ischemic or other cardiomyopathies. Multimodality imaging combined with histopathology remains key for diagnosis, while management includes corticosteroids, additional immunosuppressants in refractory cases, and device therapy for arrhythmic risk. A high index of suspicion and multidisciplinary care are essential for timely recognition and improved outcomes.