An Unusual Site for a Common Disease
A 75-year-old Asian woman presented with a 5-month history of night sweats, lethargy, and malaise. On admission she was found to have low-grade pyrexia and elevated inflammatory markers. Septic screen, which included repeated blood cultures and chest x-ray (Figure 1), were negative. A transthoracic and transesophageal echocardiography revealed a doughnut-shaped mass (online Data Supplement Movie I) that surrounded the mitral valve annulus and extended up to the left atrial walls and atrial septum. A surgical biopsy was taken (Figure 2), which showed epithelioid and langhans giant cell granulomas with central caseating necrosis consistent with tuberculosis. Special staining with high-sensitivity immunoperoxidase confirmed the diagnosis of tuberculosis. The patient was treated for tuberculosis with complete resolution of her symptoms. Repeated echocardiography 6 months later showed a dramatic reduction of the mass size (Data Supplement Movies II and III).
Isolated cardiac tuberculosis is extremely rare. However it should be included in the differential diagnosis of intracardiac masses.
Sources of Funding
Dr Boyle has received research support from the British Heart Foundation, KRUK, HHRTC, and the Broad Foundation.
Dr Boyle has received honoraria from the International Journal of Experimental Pathology, has served as a speaker for the Histochemical Society and the British Atherosclerosis Society as a member of the editorial board for the International Journal of Experimental Pathology, and as an expert witness to UK coroners and mesothelioma panels.
The online-only Data Supplement, consisting of movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/116/1/e1/DC1.