“Death at the wheel” due to tuberculosis of the myocardium: a case report

Cardiac Tuberculoma Presenting as Sudden Cardiac Death in an Immunocompetent Young Man: A Case Report and Literature Review

Tuberculosis is one of several preventable and curable communicable diseases that is a major cause of morbidity and one of the top ten causes of death worldwide. Cardiac tuberculosis frequently affects the pericardium. Although rare, most cases of tuberculosis involving the myocardium and endocardium present as sudden cardiac death in asymptomatic cases. Information about the myocardial involvement of tuberculosis appears in the literature once in a blue moon. As a result, there is a knowledge gap about cardiac tuberculosis among health professionals. Here, a case of sudden cardiac death from tuberculoma of the right atrium with a secondary thrombus causing bicaval obstruction that is observed in an asymptomatic immunocompetent young man is presented. Furthermore, challenges related to the diagnosis and management of cardiac tuberculosis are discussed, and an overview of the relevant literature is provided to break new ground in early diagnosis and therapy.

Case report: Sudden unexpected death due to tuberculous myocarditis involving sinus node at autopsy

Tuberculous myocarditis (TM) is an extremely rare manifestation of Mycobacterium tuberculosis (TB) infection. Although TM is a critical cause of sudden cardiac death, only a few cases have been reported. We report the case of an older patient with pulmonary TB with a history of fever, chest tightness, paroxysmal palpitations, and electrocardiographic evidence of sinus node conduction abnormalities on admission. Although emergency physicians observed these unusual clinical manifestations, no timely differential diagnosis was made nor interventions were performed. A definitive diagnosis of TM and histopathological findings compatible with sinus node involvement were made based on autopsy outcomes. Herein, we describe the clinical presentation and pathological features of a rare form of Mycobacterium TB. In addition, we provide an overview of issues related to the diagnosis of myocardial TB.

Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review

Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.

Myocardial tuberculosis and beyond: A rare form of extra pulmonary TB in a young boy

Myocardial tuberculosis is an exceptionally rare form of extra-pulmonary TB. Few cases were reported world-wide. Here a young snake charmer who had skin tuberculosis 5 yrs back admitted into National institute of diseases of Chest and hospital (NIDCH), Dhaka with the complaints of cough, palpitation and breathlessness for 2 months. He had right axillary firm matted lymphadenopathy, left sided large pleural effusion, left ventricular and septal hypertrophy with band and mass inside the ventricle (evident on CT scan of heart and echocardiography). His ESR was 95 mm in1st hr, Mantaux test was 15mm, Pleural fluid was exudative lymphocyte predominant with adenosin deaminase (ADA) 68.6 U/L. Fine needle aspirates from right axillary LNs showed Mycobacterium tuberculosis on GeneXpert for MTB/RIF testing and caseous granuloma on cytopathological study. Whole Body F18 FDG PET-CT revealed numerous low FDG avid size significant lymph nodes in right side of neck, mediastinum and right axilla with cardiomegaly with focal FDG avid within the left ventricular cavity likely to be prominent papillary muscle. MRI of heart or Myocardial biopsy for histology was not done due to their cost and invasiveness and also for that there was sufficient evidence of having tuberculosis in lymph node, pleura nas myocardium. This patient was treated with anti tubercular medications (3HRZE2S/5HRE) with prednisolone for six months. After treatment, myocardial lesions, pleural effusion and lymphadenopathy were found resolved. Thus a case of fatal and serious tuberculosis was explored and managed successfully.

Thoracic Cardiovascular Complications of Tuberculosis

ABSTRACT

Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.

Mycobacterium smegmatis causing a granulomatous cardiomediastinal mass

Non-tuberculous mycobacterial species are uncommon human pathogens. They are divided into slow and rapid growing mycobacteria (RGM) with Mycobacterium smegmatis group as an uncommon pathogen among the RGM.

A 19 years old male presented with a 1 month history of dyspnea, orthopnea, unintentional weight loss, palpitation, flu-like symptoms and dry cough. Physical examination revealed tachycardia, distended superficial chest veins with a decrease in breath sounds at the right lower lung with fine crepitations. CT of the chest showed a large anterior mediastinal mass infiltrating the pericardium and three chambers of the myocardium that was confirmed using echocardiography. Despite negative workup for tuberculosis, the patient was treated successfully using first-line anti-TB treatment, which was begun before the tissue culture grew M. smegmatis.

To our knowledge, this is the first case in the literature of M. smegmatis infection mimicking cardiomediastinal tuberculoma, and RGM should be suspected in similar presentations with negative TB workup, even in an immunocompetent patient. This is also the first patient to be treated using only first-line anti-tuberculous treatment successfully in the literature.

A systematic review exploring the relationship between infection and sudden unexpected death between 2000 and 2016: A forensic perspective

Death due to infectious diseases is a major health concern worldwide. This is of particular concern in developing countries where poor-socio economic status and a lack of healthcare resources contribute to the high burden of disease. In some cases death due to infection can be acute and aggressive, and death may occur without a diagnosis whilst the person is still alive. These deaths may ultimately lead to a medico-legal autopsy being performed. There are various mechanisms by which sudden death due to infection may occur. In addition, there are many risk factors associated with sudden death due to infection, which differ between infants and older individuals. However, it is unclear which pathogens and risk factors are most frequently associated with sudden death due to infection. Therefore a systematic review of articles and case reports published between 1 January 2000 and 30 June 2016 was undertaken in order to (1) explore the relationship between pathogens and their causative role and (2) identify the relationship between predisposing and/or risk factors associated with sudden death due to infection. Major databases were searched and after critical appraisal 143 articles were identified. It was found that respiratory infections and deaths involving bacterial pathogens were most commonly associated with these deaths. In addition the most common risk factors in infants were exposure to tobacco smoke and co-sleeping. In adults the most common risk factors were co-morbid conditions and illnesses. This information aids in a better understanding of these deaths and highlights the need for more research in this field, particularly in developing countries.