Left Ventricular Tubercular Myocarditis with Unique Imaging Features on Cardiac MRI: A Case Report.

Area of Science:

• Cardiology
• Infectious Diseases
• Radiology

Background:

• Myocarditis is an uncommon but serious manifestation of tuberculosis (TB).
• Early diagnosis and treatment are crucial for managing TB-related cardiac complications.
• Cardiac magnetic resonance imaging (MRI) is vital for evaluating myocardial diseases.

Purpose of the Study:

• To present a case of disseminated tuberculosis presenting as tubercular myocarditis.
• To illustrate the characteristic cardiac MRI findings in this rare condition.
• To emphasize the importance of considering TB in myocarditis cases, especially in endemic regions.

Main Methods:

• Case report of an adult patient from a TB-endemic area.
• Detailed analysis of cardiac MRI findings, including late gadolinium enhancement patterns.
• Diagnostic confirmation through fine-needle aspiration cytology of lymph nodes.

Main Results:

• The patient presented with sudden arrhythmias and was diagnosed with disseminated TB and myocarditis.
• Cardiac MRI revealed heterogeneous left ventricular signal intensity, altered nulling, and a "zebroid-like" late gadolinium enhancement pattern.
• Necrotic lymphadenopathy with epithelioid granulomas confirmed TB.

Conclusions:

• Disseminated tuberculosis can manifest as myocarditis with specific cardiac MRI characteristics.
• The "zebroid-like" pattern on cardiac MRI is a key finding for diagnosing tubercular myocarditis.
• Prompt initiation of anti-tubercular therapy led to significant clinical improvement.