Infección del miocardio por Mycobacterium tuberculosis: una localización infrecuente de una infección antigua / Myocardial tuberculosis: an infrequent location of a long-standing infection

La tuberculosis miocárdica es una localización infrecuente que, en general, se caracteriza por cuadros clínicos silentes. Su diagnóstico se basa en la alta sospecha clínica y hallazgos inespecíficos en las imágenes cardíacas, pero la histopatología continúa siendo el estándar de oro para establecer el diagnóstico. La terapia antituberculosa ha sido exitosa, presentando mejoría radiológica y clínica en la mayoría de los casos. Presentamos el caso de una infección miocárdica por Mycobacterium tuberculosis en un hombre de 34 años que consultó por un cuadro de disnea de varias semanas de evolución. Se pesquisó un derrame pleural derecho y pericárdico grave, sin signos de taponamiento cardíaco. La RPC para M. tuberculosis en líquido pleural resultó positiva. El estudio histológico de pericardio y miocardio evidenció una pericarditis crónica y una inflamación granulomatosa, no necrosante, con células gigantes multinucleadas en el tejido miocárdico. Se estableció el diagnóstico de tuberculosis pleural, pericárdica y miocárdica y se inició tratamiento antituberculoso, presentando una mejoría clínica significativa.

Myocardial tuberculosis is a rare location that is generally characterized by silent clinical pictures. Diagnosis is based on high clinical suspicion and some nonspecific findings on cardiac imaging, but histological findings remain the gold standard. Treatment with standard antitubercular drugs llave been successful, presenting radiological and clinical improvement in most cases. We report a case of myocardial infection by Mycobacterium tuberculosis in a 34-year-old man, who presented with several weeks of dyspnea and evidence of right pleural effusion and severe pericardial effusion, without signs of cardiac tamponade. PCR for M. tuberculosis was positive in pleural fluid. The histologic study of pericardium and myocardium showed myocardial fibers with non-necrotizing granulomatous inflammation with multinucleated giant cells. Due to all the above, a diagnosis of pleural and myocardial tuberculosis was made, and tuberculosis treatment was started with significant clinical improvement.

Tuberculous aortitis

Tuberculous aortitis [TA] is a rare entity that is invariably indicative of disseminated tuberculosis. TA is associated with aneurysm formation in about half of cases. Another possible complication is perforation of adjacent structures [1-7]. Both abdominal and thoracic aorta are involved with equal frequency.[7-9] Fatal outcomes are frequently reported even after antituberculosis chemotherapy and surgical intervention. We present a case of tuberculous aortic aneurysm [TBAA] that underwent surgical resection and graft replacement in the bed of the infected aorta. Following an apparently successful chemotherapy, the patient died suddenly. We postulate that reactivation of the un-eradicated bacilli precipitated graft failure. Similar cases in the literature are reviewed. We propose lifelong suppressive therapy with antituberculosis agents to prevent such a catastrophic event

Tuberculose miocárdica: relato de um caso e revisäo da literatura / Myocardial tuberculosis: report of a case and review of the literature

O acometimento cardíaco na tuberculose é pouco freqüente devido a uma provável resistência natural do miocárdio a infecçäo pelo Mycobacterium tuberculosis. Säo descritas quatro formas de doença no coraçäo: nodular, difusa infiltrativa e miocardite intesticial inespecífica. As vias de contaminaçäo do miocárdio säo a disseminaçäo hematogênica, a drenagem linfática retrógrada a partir de linfonodos mediastinais contaminados e a infecçäo por contiguidade direta com o pericárdio. A ausência de sintomatologia clínica específica e a dificuldade na identificaçäo de bacilos álcool-resistentes tornam dificil o diagnóstico clínico, contribuindo para a evoluçäo desfavorável na maioria dos casos. Os autores apresentam um caso de tuberculose do miocárdio com acometimento valvar, em doente jovem do sexo feminino tratada cirurgicamente e atualmente no sexto mês de acompanhamento