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.

Endovascular salvage of tubercular aortitis presenting as descending thoracic aortic pseudoaneurysm in association with vertebral tuberculosis.

A gentleman in his late 30s presented with a history of evening rise of temperature and generalised malaise of 1-week duration. He had associated upper back pain with tingling and numbness of both lower limbs. An unexplained episode of hypotension with hemoptysis propelled a computed tomography (CT) examination of chest which was suggestive of a pseudoaneurysm of the posterior wall of descending thoracic aorta in the vicinity of the Pott's spine with a prevertebral and paravertebral abscess, for which he was referred to vascular surgeons.Tubercular involvement of vasculature is a rare disease, aortic involvement even rarer. Less than 50 cases of vertebral tuberculosis with tubercular thoracic aortic aneurysm have been reported in the medical literature, but the disease carries a colossal mortality and morbidity.After a multidisciplinary teamwork, thoracic endovascular aortic repair was done for exclusion of the aneurysmal segment, with simultaneous antitubercular and broad-spectrum antibiotic chemotherapy. The patient recuperated well.

Chest pain and a left parasternal soft tissue swelling in an immunocompetent refugee with disseminated tuberculosis.

An immunocompetent migrant with chest pain was admitted to an Italian hospital. Computed tomography showed a left pectoral abscess and osteomyelitis of the sternum. The infection had spread into the anterior mediastinum near to the pericardium and the heart, where an atrial mass was confirmed by echocardiography. Disseminated tuberculosis was diagnosed.

Tuberculous False Aneurysm of the Aortic Isthmus Treated Using Stent Grafts.

Tuberculous aortic aneurysms are rare. Localization in the isthmus of the aorta is still exceptional. It often presents as a false aneurysm, which exposes to the risk of rupture, whatever the size of the aneurysm, and worsens the prognosis. The treatment of reference relies on surgery in association with antituberculosis treatment. The endovascular approach with stent grafts can be an alternative as presented in this case report, in which traditional surgery was judged to be at risk in a nonagenarian patient.

Endografting under Assistance of Transapical Body Floss Through-and-Through Wiring Technique and Rapid Ventricular Pacing for an Ascending Aortic Tuberculous Pseudoaneurysm.

BACKGROUND: To demonstrate an ascending aortic tuberculosis pseudoaneurysm successfully treated with endografts under assistance of trans-apical body floss wiring technique and rapid ventricular pacing support. METHOD AND RESULT: A 77-year-old woman with a non-healing anteromedial chest wound presented with sudden hypotension and hemoptysis. The computed tomography (CT) scan revealed a 9-cm-diameter pseudoaneurysm of ascending aorta, with sternal erosion close to the wound. Conventional open repair was not preferred due to possible contamination of interposition graft and difficult sternum closure. The feasibility of endografting was confirmed based on appropriate landing zones. After endografts modification at back table, we made a left mini-thoracotomy and establish a through-and-through body floss wire from left ventricular apex to femoral artery. Retrograde delivery over this wire from femoral artery to ascending aorta and deployment of endografts under rapid ventricular pacing support were performed smoothly. Final angiography showed no endoleaks with patent coronary and arch vessels. Further wound debridement was done at the same time and wound culture yielded tuberculosis. After completing anti-tuberculosis therapy, no recurrent infection occurred. Postoperative 6-month CT scan disclosed optimal result. CONCLUSION: With adequate landing zones and delicate surgical strategy, endografting with anti-tuberculosis therapy may be an alternative treatment for ascending aortic tuberculosis pseudoaneurysm.

Disseminated tuberculosis - diagnostic challenges of atrial tuberculoma masquerading as atrial myxoma.

A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities. She was noted to have a vague central abdominal mass and a systolic murmur over the mitral region. Ultrasonography and computed tomography of the abdomen showed an omental mass and loculated ascites. Oesophagoduedenoscopy showed antral gastritis and during colonoscopy the surgical team was unable to advance the scope beyond 40 cm due to external compression. An echocardiogram showed a right atrial mass and a pericardial effusion over the posterior wall. A possible diagnosis of atrial myxoma was made. Sputum acid-fast bacillus was negative. The patient was treated empirically for disseminated tuberculosis and scheduled for bronchoscopy by the pulmonology team. The patient showed remarkable improvement after day 7 of anti-tuberculosis medication. GeneXpert study came back as positive. CT abdomen and echocardiogram repeated after 2 weeks of treatment showed reduction in the mass.

Unusual presentation of a young man with disseminated tuberculosis and right ventricular mass.

We report a 22-year-old man who presented to the emergency department with worsening shortness of breath and chronic fever for 2 months. Physical examination was unremarkable except for raised jugular venous pressure and palpable liver. Echocardiogram showed a large right ventricular mass causing obstruction at tricuspid valve. A subsequent chest CT scan confirmed the presence of a large mass in the right ventricle. There were multiple enlarged lymph nodes and consolidation in the right upper lobe. Diagnosis of disseminated tuberculosis (TB) was made and later confirmed by histopathology of lymph node biopsy along with positive sputum culture for acid-fast bacilli. Remarkable recovery was observed on antituberculous therapy, with complete disappearance of the cardiac mass on echocardiogram, at 1-year follow-up. Although unusual and rare, myocardial involvement as a large mass should be kept in mind while treating patients with disseminated TB.

[Myocardial tuberculoma: unusual location of tuberculosis: a new observation and review of the literature]. / Tuberculome myocardique: localisation inhabituelle de la tuberculoseà propos d'une nouvelle observation avec une revue de la littérature.

We report the case of a 50-year old patient with a left ventricular tumor whose evolution was marked by impaired general condition and fever. This mass was objectified by echocardiography performed to explore a radiological cardiomegaly. The imaging (MRI) appearance was suggestive of an intra-myocardial tuberculoma Based on our observations, we propose a review of the literature on this unusual location of tuberculosis.

A 1-Year-Old with Mycobacterium tuberculosis Endocarditis with Mass Spectrometry Analysis of Cardiac Vegetation Composition.

In this study, we report the first case of Mycobacterium tuberculosis endocarditis in an immunocompetent child born in the United States. Mass spectrometry of the vegetation identified coagulation, humoral immune proteins, neutrophil granule proteins, and histones. Few neutrophils on histopathology suggest that neutrophil extracellular traps may contribute to tuberculous endocardiac mass formation.

Intra-Cavitary Masses: Rare Presentation of a Common Illness in SAARC Nation.

Cardiovascular tuberculosis (TB) is a relatively uncommon manifestation of Mycobacterium tuberculosis infection. TB can affect all three layers of the heart; endocardial tuberculoma is the rarest form. Endocardial tuberculoma, when it occurs, can easily be confused with other common causes of intracardiac mass lesions, especially in echocardiography. Timely diagnosis and appropriate treatment is essential, as only this can lessen the associated morbidity and mortality. Here, a case of cardiovascular TB has been described in a middle-aged woman from the SAARC nation; the woman presented with simultaneous pericardial constriction and multichamber endocardial tuberculoma. Combined pharmacological and surgical approach was successful.

Infectious Myocarditis on FDG-PET Imaging Mimicking Sarcoidosis.

Cardiac positron emission tomography with fluorine-18 fluorodeoxyglucose (FDG-PET) is often used for the diagnosis of cardiac involvement in sarcoidosis. Areas of segmental perfusion defects coupled with FDG uptake are considered to represent active inflammation. However, these findings may be associated with other inflammatory myocardial diseases. We describe a case of tuberculous myocarditis with imaging findings mimicking those found in cardiac sarcoidosis.

Primary repair of tuberculous pseudoaneurysm of the aortic arch.

We report a successful primary repair of a tuberculous pseudoaneurysm of the aortic arch by open surgery.