Standard anti-tubercular treatment resulted in clinical improvement and regression of myocardial thickening and brain lesions in a patient with myocardial tuberculosis.
Case Report (n=1)
Multimodality imaging and endomyocardial biopsy are valuable for diagnosing rare myocardial tuberculosis presenting as right ventricular cardiomyopathy, which can be successfully treated with standard anti-tubercular therapy.
An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose ( FDG) -positron emission tomography ( PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis.
Singhal et al. (Sat,) conducted a case report in Myocardial tuberculosis (n=1). Standard anti-tubercular treatment was evaluated. Standard anti-tubercular treatment resulted in clinical improvement and regression of myocardial thickening and brain lesions in a patient with myocardial tuberculosis.