Granulomatous Cardiomyopathy Presenting As a Paraneoplastic Syndrome in Metastatic Melanoma

Malignancy and treatment thereof is associated with granulomatous reactions that can mimic metastatic disease. We present a rare manifestation of metastatic melanoma with paraneoplastic cardiopulmonary granuloma deposition, first thought to represent malignant infiltration of the myocardium. Multi-modality imaging with positron emission tomography-computed tomography and cardiac magnetic resonance imaging, along with histologic examination, was critical in reaching a diagnosis. Interdisciplinary management was essential to achieving the best outcome for the patient, for managing both the primary malignancy and its cardiac complications.