Intramyocardial tuberculosis: A rare underdiagnosed entity.

Abstract

Background: Tuberculosis (TB) remains a public health concern in the Third World countries. Though TB is a fairly common cause of pericardial disease in our country, myocardial tuberculosis is extremely rare and often not diagnosed during life.
Aim: To highlight a poorly clinically recognized form of tuberculosis as an important
cause of sudden death .
Material: A case report and literature review..
Results:
Case 1: A 38 year old fit, kickboxer and a known steroid user collapsed and died while presenting with shortness of breath for the first time in casualty. At autopsy, a large nodular aneurismal fibrous thickening in the mitral valve cusp was noted, with extensive fibrous thickening of the tricuspid valve cusp and multiple small infiltrative abscesses proximal to aortic valve cusp and extending to the myocardium.
Histology examination showed necrotizing granulomatous inflammation involving the myocardium and paratracheal lymph node. Acid fast bacilli were noted There was no evidence of TB in the lungs and other organs.
Case 2: 21 year old male, nausea and vomiting for one day, collapsed and died, whilst vomiting inside the toilet. At autopsy, a firm, hollow yellowish mass with a thrombus within its cavity, just below the aortic outflow tract in the left ventricle. Lungs were normal, but paratracheal ymph nodes enlarged. Zielh Neelsen stain: No acid fast bacilli noted. (Literature review shows that myocardial tissue specimens often fail to reveal acid-fast bacilli and definitive diagnosis rests on seeing typical histological changes)
Conclusion: Myocardial tuberculosis is very rare, often not diagnosed clinically and most of the literature is based on autopsy reports.