[An isolated tuberculoma in the left ventricle]

In the course of 8 weeks, a 62-year-old woman with chronic bronchitis developed increasing dyspnoea on effort and reduced well-being. The chest radiograph revealed a round focus, 2 x 3 cm, in the region of the left ventricle which, from the results of echocardiography and left-heart catheterization, suggested myxoma. At open-heart surgery under extracorporeal circulation an encapsulated tumour was found on the mural leaflet of the mitral valve, directly caudal of the atrioventricular plane. On opening, the capsule contained dough- or paste-like, yellowish-white substance with scattered polygonal granules, typical of a tuberculoma. The entire contents and capsule were excised. Immediately after operation tuberculostatic treatment was initiated (three times daily ethambutol, 400 mg, and once daily rifampicin, 600 mg, and isoniazid, 300 mg), even though acid-fast rods were not demonstrated histologically and by culture. Polymerase chain reaction, however, established the presence of Mycobacterium tuberculosis in the resected material. There was no evidence of florid tuberculosis in the subsequent course.