Intramyocardial tuberculosis

Dhall, A.; Sharma, V.; Dhawan, S.; Yadav, S.; Yadav, O.P.; Lahiri, S.; Khanna, PK.; Sawhney, JPS; Mantri, RR; Mehta, A.; Chopra, V.K.; Passey, R.; Kandpal, B. and Jain, R. (2002) Intramyocardial tuberculosis. Indian Heart Journal, 54. 388.

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Abstract

Myocardial tuberculosis was rare even in the days before effective anti-tuberculous treatment was available and was usually an incidental finding at post-mortem. After the introduction of anti-tuberculous chemotherapy, the incidence of myocardial tuberculosis was reported to be less than 0.1% of tuberculous infections. We present two such cases in our experience. The first case was that of a 19-year-old woman who had been admitted with pyrexia of unknown origin. She was screened for investigations for PUO, including liver and bone biopsies, but to no avail. Echocardiography revealed biatrial masses arising from the anterior wall of the right atrium causing SVC obstruction. The patient was taken up for surgery and a frozen section revealed the inflammatory origin of the mass, most likely of tubercular etiology. The postoperative course was uneventful. The second case was that of a 57-year-old male who was admitted as a case of anterior wall MI. CAG revealed 100% occlusion of the LAD with impaired LV function. He was taken up for OPCAB with planning of a LIMA-to-LAD graft. During dissection of the myocardium, white cheesy material came out of the myocardium and a large myocardial abscess was found in the anterior wall of the LV and some portion of the RV. The LAD was buried within the myocardial abscess and there were dense pericardial adhesions. The abscess cavity was thoroughly cleaned. Myocardial biopsy from the edge of the abscess cavity revealed granulomatous inflammation with lymphocytic infiltration and plasma cells. ZN staining revealed typical acid-fast bacilli; and cultures grew M. tuberculosis sensitive to rifampicin, ethambutol, pyrazinamide and streptomycin.

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