Immediately after the cardiac MRI four years ago, the patient received systemic immunotherapy and was then referred to a major cardiac centre, where she received another cardiac MRI two months after the first. They found that late gadolinium enhancement (LGE), mild systolic dysfunction and pericardial effusion was unchanged, but they did not find any early gadolinium enhancement (EGE) or cardiac oedema.
A subsequent endomyocardial biopsy showed focal interstitial fibrosis, with inflammatory cells and granulomatous inflammation consistent with the cardiac manifestation of sarcoidosis. Eosinophil and giant cell myocarditis as a potential differential diagnosis for the late gadolinium enhancement were histologically ruled out and thus the diagnosis of cardiac sarcoidosis was established.