Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report

BMC Infectious Diseases, Dec 2011

Background Cardiac tuberculosis is rare and usually manifests as tuberculous pericarditis. Involvement of other part of the heart is unusual and descriptions in the pediatric literature are confined to few case reports regarding mainly myocardial tuberculosis. Case presentation We describe a case of pulmonary miliary tuberculosis associated with intracardiac left atrial tuberculoma in an immunocompetent eleven-month-old infant successfully treated with surgery and antituberculous therapy. Conclusion Although unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind.

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Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report

BMC Infectious Diseases Intracardiac left atrial tuberculoma in an eleven- month-old infant: case report Cantinotti M 2 De Gaudio M 0 1 de Martino M 0 1 Assanta N 2 Moschetti R 2 Veneruso G 0 1 Crocetti M 2 Murzi B 2 Chiappini E 0 1 Galli L 0 1 0 Department of Sciences for Woman and Child's Health, University of Florence, Anna Meyer Children's University Hospital , Florence , Italy 1 Department of Sciences for Woman and Child's Health, University of Florence, Anna Meyer Children's University Hospital , Florence , Italy 2 G. Monasterio Tuscan Foundation, Heart Hospital, National Research Institute , Massa , Italy Background: Cardiac tuberculosis is rare and usually manifests as tuberculous pericarditis. Involvement of other part of the heart is unusual and descriptions in the pediatric literature are confined to few case reports regarding mainly myocardial tuberculosis. Case presentation: We describe a case of pulmonary miliary tuberculosis associated with intracardiac left atrial tuberculoma in an immunocompetent eleven-month-old infant successfully treated with surgery and antituberculous therapy. Conclusion: Although unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind. - Background Tuberculosis (TB) is one of the top ten causes of death among children worldwide and it is a direct consequence of adult TB [1]. In the natural history of childhood pulmonary TB, primary infection before two years of age frequently progresses to disease within twelve months [2]. Young age and human immunodeficiency virus type 1 (HIV-1) infection are the most important risk factors for severe or disseminated disease [2,3]. The involvement of the heart in TB is a very rare clinical condition both in adults and children [4,5]. We report here a case of pulmonary miliary TB associated with intracardiac left atrial tuberculoma in an eleven-monthold infant successfully treated with surgery and antituberculous therapy. Case presentation An eleven-month-old female infant was referred to her local hospital for a 2-week history of intermittent fever, cough, dyspnea, night sweats and poor feeding. She was initially treated with amoxicillin-clavulanic acid for presumed upper respiratory tract infection without improvement. On examination, she was underweight for age, had a temperature of 37.5C, pulse was regular with a rate of 130 beats per minute, blood pressure was normal, transcutaneous oxygen saturation was 96% on room air, and respiration rate was 40 breaths per minute. A few crackles were heard bilaterally and a mild systolic murmur was noted. She had soft, mobile, non tender, small volume cervical lymph nodes with normal overlying skin and no evidence of discharge. The rest of the clinical examination was unremarkable. A complete blood count at presentation revealed a hemoglobin of 10.4 mg/dL, white cell count of 18 103 cell/L with neutrophilia, and a platelet count of 660 103cell/L. Both biochemistry profile and C reactive protein levels were normal. HIV-1 serology was nonreactive. Chest X-Ray (CXR) revealed diffuse, bilateral, small lung nodules which could suggest acute pulmonary miliary TB (Figure 1). The tuberculin skin test (TST) and the QuantiFERONTB Gold test were negative. Results of acid-fast bacilli (AFB) smears on three early morning gastric aspirates were negative. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex and colture on gastric aspirates were pending. Family members were investigated for TB, but both parents had negative CXR and TST and the source of infection was not identified. On day 3 after admission due to the presence of a mild systolic murmur and the persistence of intermittent dyspnea, echocardiography (ECHO) was performed Figure 1 Chest X-Ray. Diffuse, bilateral, small lung nodules suggestive of acute miliary pulmonary tuberculosis. and revealed a voluminous left atrial intracavitary pedunculated mass prolapsing during the diastole from the right lower pulmonary vein into the left ventricle through the mitral valve (Figure 2). No mitral stenosis and only trivial mitral regurgitation were noted. The patient was immediately transferred to the cardio-surgical unit and complete excision of an homogeneous and yellowish in color mass was performed through median sternotomy, under cardiopulmonary bypass. Histopathological examination of the removed mass revealed fibrotic tissue with mixed inflammatory cells and necrotic debris with a vaguely granulomatous appearance and AFBs were found. PCR for Mycobacterium tuberculosis complex was positive on the removed mass and on previous gastric aspirates. Three days after surgery, a chest computed tomography (CT) scan revealed widespread miliary nodules, compatible with acute pulmonary miliary TB and showed a right upper lobe consolidation (Figure 3). The cranial contrast-enhanced CT scan and the abdominal ultrasound were normal. Antituberculous therapy with streptomycin (20 mg/kg intramuscularly once d (...truncated)


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Cantinotti M, De Gaudio M, de Martino M, Assanta N, Moschetti R, Veneruso G, Crocetti M, Murzi B, Chiappini E, Galli L. Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report, BMC Infectious Diseases, 2011, pp. 359, 11, DOI: 10.1186/1471-2334-11-359