An autopsy case of ancient sarcoidosis associated with severe fibrosis in the liver and heart.

An autopsy case of ancient sarcoidosis with severe fibrosis in the liver and heart was reported. The patient was a 61-year-old female when she died, 12 years after the onset of sarcoidosis. Cervical lymph node biopsy at 49 years demonstrated non-necrotizing sarcoid granuloma, and laboratory data were compatible with sarcoidosis. Liver and heart failure were observed clinically, and because of heart failure a pacemaker was implanted. She died of septic shock at 61 years. At autopsy, the liver demonstrated cirrhotic severe fibrosis, cholestasis, and acute cholangitis without mechanical bile duct obstruction. In the heart, severe fibrosis was observed, and infectious foci of candida infection were observed on the cardiac valves. Although both liver and heart did not show typical sarcoid granuloma, fibrosis was thought to be due to sarcoidosis because no other causes of liver and heart fibrosis were identified clinically or pathologically. There were systemic foci of candida infection, and she died of sepsis due to candida infection. It was speculated that immunological impairment induced candida infection. This case seems to be a rare and important case of ancient sarcoidosis.