Tuberculous myopericarditis: a rare presentation in an immunocompetent host

Area of Science:

• Cardiology
• Infectious Diseases
• Pulmonology

Background:

• Tuberculosis (TB) is a significant cause of pericardial disease, particularly in endemic regions like India.
• While pericardial involvement is common, myocardial involvement (myocarditis) secondary to tuberculosis is a rare but serious manifestation.

Observation:

• A case of disseminated tuberculosis presenting with myopericarditis leading to cardiogenic shock is described.
• The patient exhibited symptoms indicative of severe cardiac dysfunction due to tuberculous infection.

Findings:

• The patient showed gradual clinical improvement with a combination of antituberculosis drug therapy, corticosteroid administration, and guideline-directed heart failure management.
• Follow-up cardiac imaging revealed significant pericardial calcification and a notable improvement in left ventricular systolic function, indicating recovery from myopericarditis.

Implications:

• This case highlights the importance of considering myocardial involvement in disseminated tuberculosis, even when rare.
• Successful management underscores the efficacy of a multi-modal treatment approach, combining anti-infective therapy with advanced heart failure care.
• The findings suggest that prompt and comprehensive treatment can lead to favorable cardiac outcomes, including functional recovery and prevention of long-term sequelae like pericardial constriction.