Successful Heart Transplantation in a Patient With Triple Infiltrative Cardiomyopathy: Sarcoidosis, AL and TTR Amyloidosis.

BACKGROUND: Although "dual pathology" cardiac amyloidosis cases (amyloid light chain [AL] and transthyretin [TTR]) have been described, the coexistence of cardiac sarcoidosis with TTR amyloidosis is extremely rare, with only 2 case reports described in Japan to date. REPORT SUMMARY: We describe a unique case of a triple pathology consisting of cardiac sarcoidosis and both AL and TTR amyloidosis identified in myocardial tissue by liquid chromatography tandem mass spectrometry as well as advanced cardiac magnetic resonance and fluorodeoxyglucose positron emission tomography scans in the same patient. DISCUSSION-NOVELTY: To the best of our knowledge, this is not only the first patient with a triple infiltrative cardiac pathology but also the first such patient who underwent successful heart transplantation, with the above pathologies confirmed by the explanted native heart. TAKE-HOME MESSAGE: Coexistence of cardiac sarcoidosis, TTR and AL amyloidosis in the same patient's native heart poses unique therapeutic challenges regarding post-transplantation medical management.