Clinical Presentation of a Patient With Tuberculous Myocarditis: Case Report and Review of Literature

Vennamaneni, Vamsidhar; Chohan, Farah; Rad, Pedram; Rodríguez, J. I.; Gupta, Ravi; Michel, George

doi:10.7759/cureus.22715

Cited by 6 publications

(8 citation statements)

References 5 publications

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“…Clinical diagnosis of myocarditis is warranted based on elevated cardiac markers such as Troponin I or T, creatinine kinase-MB, and reduced left ventricular function proved by echocardiographic or cardiac MR findings. 6 Our patient presented with the typical clinical findings and laboratory parameters, which, coupled with positive TB tests, confirmed the diagnosis.…”

Section: Discussionsupporting

confidence: 77%

“…A literature search on PubMed yielded no reported cases of this condition in Pakistan, despite Pakistan being a tuberculosis‐endemic country, accounting for 5.7% of the Global Tuberculosis Burden in 2020 4,5 . It is alarming that cases of tuberculous myocarditis have not been previously reported in the country, which may be due to the various non‐specific clinical findings such as congestive heart failure, conduction disorders, myocardial infarction, and sudden cardiac death and the diagnostic difficulty it imposes 6 …”

Section: Discussionmentioning

confidence: 99%

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A rare case of tuberculous myocarditis: A diagnostic challenge in a tuberculosis‐endemic country

Shaikh,

Yaqoob,

Batool

et al. 2023

Clinical Case Reports

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Key Clinical MessageTuberculous myocarditis is a rare presentation of tuberculosis, posing diagnostic challenges in endemic countries. Clinicians should consider this entity in patients with unexplained heart failure, conduction abnormalities, or sudden cardiac events in tuberculosis‐endemic regions.AbstractTuberculous myocarditis is an uncommon manifestation of tuberculosis, often presenting as a diagnostic challenge, particularly in tuberculosis‐endemic regions. We report a case of a 58‐year‐old male with a history of chronic cough and fever, who presented with progressive dyspnea, generalized body swelling, and New York Heart Association (NYHA) Class IV heart failure. Clinical examination revealed signs of cardiac decompensation and congestive heart failure. Emergency echocardiography demonstrated biventricular dysfunction, and imaging showed clots in both atria and the left ventricle. The patient responded well to initial treatment with anticoagulants, antibiotics, diuretics, and inotropic support. Subsequent investigations, including computed tomography pulmonary angiogram (CTPA) and high‐resolution computed tomography (HRCT), confirmed active pulmonary tuberculosis. Anti‐tuberculous treatment (ATT) was initiated, and the patient showed remarkable improvement. The diagnosis of tuberculous myocarditis was based on clinical, radiological, and laboratory evidence, as cardiac biopsy was not performed due to resource limitations. Tuberculous myocarditis is an underreported condition, and clinicians should be vigilant about its occurrence, especially in tuberculosis‐endemic regions. Early recognition and prompt initiation of ATT can lead to favorable outcomes. This case highlights the importance of considering tuberculous myocarditis in patients with unexplained heart failure or cardiac abnormalities in areas with a high burden of tuberculosis.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

A rare case of tuberculous myocarditis: A diagnostic challenge in a tuberculosis‐endemic country

Shaikh,

Yaqoob,

Batool

et al. 2023

Clinical Case Reports

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“…First mechanism would be inflammatory surge measured by universal marker of inflammation CRP and second is concurrent clinical or subclinical adrenal suppression as measured by serum cortisol level resulting into cardiac dysfunction. Similarly, in [27,[50][51][52][53][54][55], the researchers have mentioned similar observations.…”

Section: Risk Factors Associated With Cardiac Dysfunction (Covariates...mentioning

confidence: 53%

“…Cases with advanced pulmonary disease were having other two associated risk factors as advanced age and hypoalbuminemia. Various authors have mentioned similar plausible mechanism leading to cardiac dysfunction in advanced active pulmonary tuberculosis [27,[49][50][51][52][53].…”

Section: Risk Factors Associated With Cardiac Dysfunction (Covariates...mentioning

confidence: 99%

Cardiac dysfunction in active pulmonary tuberculosis: Mysterious facts of TB’s pandora

et al. 2023

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Introduction: Cardiac dysfunction in pulmonary tuberculosis is relatively more common and underestimated due to lack of suspicion. We have studied prevalence of cardiac dysfunction in pulmonary tuberculosis with special emphasis on echocardiography, serum cortisol and its correlation in cases with unstable cardiorespiratory parameters. Methods: Prospective, observational, complete workup, and one year follow up study conducted during January 2016 to December 2020 included 800 cases of active pulmonary tuberculosis with specified inclusion criteria of disproportionate tachycardia, tachypnea with or without hypoxia and shock. Cases with known risk factor for cardiac disease and taking cardiac medicines, and cases with pericardial effusion were excluded from study. All study cases were undergone protocolized analysis such as chest radiograph, pulse oximetry, ECG, sputum examination, cardiac enzymes (CPK-MB, NT-Pro-BNP, and cardiac troponins), serum cortisol, and echocardiography at entry point, at two and six months of treatment with anti-tuberculosis medicines as per NTEP. Statistical analysis was carried out by Chi-square test. Observations and analysis: In a study of 800 pulmonary tuberculosis cases, 56.00% (448/800) cases were males, and 44.00% (352/800) cases were females. Cases with BMI<18 was 41.62% (333/800) and BMI>18 was 58.37% (467/800). Radiological patterns as unilateral disease in 33.62% (269/800) & bilateral disease in 66.37% (531/800). Hemoglobin less than 10 gm% were documented in 85.12% (681/800) and above 10 gm% were in 14.87% (119/800) cases. Serum albumin less than 3.5 gm% and more than 3.5 gm% were observed in 48.12% (385/800) and 51.12% (415/800) cases respectively. Hypoxia was documented 26.12% (209/800) cases and normal oxygen saturation in 73.87% (591/800) cases. cases with normal and abnormal serum cortisol were 61.37% (491/800) & 38.62% (309/800) respectively. Sputum examination for AFB observed in 30.00% (240/800) and gene Xpert MTB/RIF documented in 51.37% (411/800) cases respectively. Bronchoscopy guided techniques were used in 149 cases and BAL smear AFB in 44.96% (67/149) cases, gene Xpert MTB/RIF in 97.31% (145/149) cases and MGIT culture in four cases (positive in 100% cases subjected to MGIT culture). We have observed global hypokinesia is predominant cardiac dysfunction documented in 82.21% (171/208) cases, followed by left heart systolic dysfunction in 16.34% (34/208) cases and left heart diastolic dysfunction in 75% (156/208) cases. Right heart dysfunction as dilated right atrium and right ventricle documented in 52.88% (110/208) cases and pulmonary hypertension in 40.38% (84/208) cases. Covariates such as age, gender, hemoglobin, BMI, serum cortisol, serum albumin, oxygen saturation and radiological involvement has significant association with cardiac dysfunction. (p<0.00001) Response to treatment with antituberculosis medicines and steroids has documented as improved in 77.40% cases (161/208) cases, persistent in 13.46% (28/2028) cases and progressive in 9.13% (19/208) cases. Final outcome of cardiac dysfunction in Pulmonary tuberculosis cases has significant association with serum cortisol level (p<0.00086). Conclusion: Cardiac dysfunction is active pulmonary tuberculosis needs prompt workup in presence of disproportionate tachypnea, tachycardia with or without hypoxia and shock. Echocardiography is basic tool to evaluate these cases and global hypokinesis is most common abnormality. Serum cortisol abnormality documented in fair number of cases and very well correlated with left ventricular dysfunction abnormalities. Steroids with antituberculosis treatment backup is mainstay protocol during management of these cases. Cardiac dysfunction is reversible in majority of cases and proportionate number shown complete improvement in cardiac dysfunction.

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“…Management from case reports published is tailored to the individual presentation of the patient and complications that arise. Table 3 gives a summary of some case reports that have been published on tuberculous myocarditis [43,[47][48][49][50].…”

Section: Tuberculous Myocarditis and Sudden Cardiac Deathmentioning

confidence: 99%

Tuberculosis and Cardiovascular Complications: An Overview

Adefuye¹,

Manjunatha²,

Ganduri³

et al. 2022

Cureus

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Tuberculosis (TB) is a dominant cause of mortality from a single infectious disease agent. It is a global health issue that has been tagged as a public health emergency for decades. The disease process, which is caused by Mycobacterium tuberculosis (MTB), affects the respiratory system as well as many other organ systems in the body, such as the lymphatic system, central nervous system (CNS), gastrointestinal system, and cardiovascular system (CVS). Generally, cardiovascular diseases are the leading cause of death worldwide, with most of the mortality in low and middle-income countries. Also, the high mortality rate of TB is skewed to these regions, making the mortality of TB with CVS involvement exceptionally high.The multisystemic involvement of TB impacts the cardiovascular system in various forms. While pericarditis caused by TB is quite common, other complications like myocarditis, coronary artery disease, and aortitis are rarer, necessitating a high index of suspicion and holistic management. This article reviews the pathophysiology of cardiovascular complications in TB, highlighting mechanisms of occurrence, common complications, management protocols, and prognostic factors. Our review highlights some of the gaps in understanding cardiovascular complications in TB, necessitating further research to investigate causal mechanisms and treatment.

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Clinical Presentation of a Patient With Tuberculous Myocarditis: Case Report and Review of Literature

Cited by 6 publications

References 5 publications

A rare case of tuberculous myocarditis: A diagnostic challenge in a tuberculosis‐endemic country

A rare case of tuberculous myocarditis: A diagnostic challenge in a tuberculosis‐endemic country

Cardiac dysfunction in active pulmonary tuberculosis: Mysterious facts of TB’s pandora

Tuberculosis and Cardiovascular Complications: An Overview

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