Khasnavis S, Sakul S, Novakovic M, Adinugraha P, Mehta D. Cardiac sarcoidosis with a twist - active and fibrotic sarcoid with antiphospholipid positivity: A case report. World J Cardiol 2025; 17(12): 112389 [DOI: 10.4330/wjc.v17.i12.112389]
Corresponding Author of This Article
Sujoy Khasnavis, Researcher, Department of Medicine, Jacobi North Central Bronx Hospital, 111 East 210th Street, Bronx, NY 10467, United States. sujoy.khasnavis@gmail.com
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Medicine, Research & Experimental
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 26, 2025 (publication date) through Dec 24, 2025
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World Journal of Cardiology
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Khasnavis S, Sakul S, Novakovic M, Adinugraha P, Mehta D. Cardiac sarcoidosis with a twist - active and fibrotic sarcoid with antiphospholipid positivity: A case report. World J Cardiol 2025; 17(12): 112389 [DOI: 10.4330/wjc.v17.i12.112389]
World J Cardiol. Dec 26, 2025; 17(12): 112389 Published online Dec 26, 2025. doi: 10.4330/wjc.v17.i12.112389
Cardiac sarcoidosis with a twist - active and fibrotic sarcoid with antiphospholipid positivity: A case report
Sujoy Khasnavis, Sakul Sakul, Marko Novakovic, Paulus Adinugraha, Davendra Mehta
Sujoy Khasnavis, Department of Medicine, Jacobi North Central Bronx Hospital, Bronx, NY 10467, United States
Sakul Sakul, Marko Novakovic, Paulus Adinugraha, Davendra Mehta, Department of Cardiology, Mount Sinai Morningside, New York, NY 10025, United States
Author contributions: Khasnavis S conceptualized the topic; Khasnavis S and Sakul wrote the manuscript; Novakovic M prepared relevant images for the manuscript; Sakul and Adinugraha P edited the manuscript; Mehta D supervised the preparation of the manuscript.
Informed consent statement: Informed consent was obtained from the patient described in this case report.
Conflict-of-interest statement: All authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sujoy Khasnavis, Researcher, Department of Medicine, Jacobi North Central Bronx Hospital, 111 East 210th Street, Bronx, NY 10467, United States. sujoy.khasnavis@gmail.com
Received: July 31, 2025 Revised: September 7, 2025 Accepted: November 7, 2025 Published online: December 26, 2025 Processing time: 147 Days and 7.2 Hours
Abstract
BACKGROUND
Cardiac sarcoidosis (CS) is an infiltrative disease with manifestations such as non-sustained ventricular tachycardia (NSVT) and heart failure (HF). Antiphospholipid syndrome (APS) and antiphospholipid positivity (APP) are prothrombotic phenomena which elevate risk for thromboembolism. CS with active systemic sarcoid and APS/APP is a rare combination of diseases.
CASE SUMMARY
A 54 year old male with HF presented with several cardiopulmonary symptoms. Chest imaging showed bilateral patchy and reticulonodular infiltrates. Subsequent lung biopsy confirmed pulmonary sarcoidosis. Positron emission tomography revealed active systemic sarcoidosis (SS) and fibrotic CS. Positive antiphospholipid antibodies without thromboembolism confirmed APP. HF and APP were managed with medical therapy. Fibrotic CS and NSVT required permanent cardiac device and antiarrhythmic therapy. SS was managed with early taper of steroids and transition to biologics.
CONCLUSION
Fibrotic CS with active SS and APS/APP has not been previously described in literature. This case utilized a modified approach for the management of this combination of diseases. As immunosuppressants such as steroids have limited utility in fibrotic sarcoidosis and a potential for thromboembolic complications in the presence of APP, an accelerated transition to non-thrombotic immunosuppressants can be advantageous in the long term treatment of this combination of diseases.
Core Tip: Fibrotic cardiac sarcoidosis with concomitant active systemic sarcoidosis and antiphospholipid positivity are unreported in literature. The various systemic manifestations of this combination of diseases require intricate medical management. As traditional immunosuppressants have limited utility in burnt sarcoidosis and concurrent antiphospholipid positivity raises risks for thromboembolic disease, essential management strategies include close monitoring of antiphospholipid disease and timely tapering from thrombotic to non-thrombotic immunosuppressants.
