1
|
Zhang L, Yan H, Wang Y, Huang F. Case report: Sudden unexpected death due to tuberculous myocarditis involving sinus node at autopsy. Front Cardiovasc Med 2023; 10:1159292. [PMID: 37396574 PMCID: PMC10308008 DOI: 10.3389/fcvm.2023.1159292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Tuberculous myocarditis (TM) is an extremely rare manifestation of Mycobacterium tuberculosis (TB) infection. Although TM is a critical cause of sudden cardiac death, only a few cases have been reported. We report the case of an older patient with pulmonary TB with a history of fever, chest tightness, paroxysmal palpitations, and electrocardiographic evidence of sinus node conduction abnormalities on admission. Although emergency physicians observed these unusual clinical manifestations, no timely differential diagnosis was made nor interventions were performed. A definitive diagnosis of TM and histopathological findings compatible with sinus node involvement were made based on autopsy outcomes. Herein, we describe the clinical presentation and pathological features of a rare form of Mycobacterium TB. In addition, we provide an overview of issues related to the diagnosis of myocardial TB.
Collapse
Affiliation(s)
- Le Zhang
- Forensic Science Center, Gannan Medical University, Ganzhou, China
| | - He Yan
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yufang Wang
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Feijun Huang
- Department of Forensic Science, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
Collapse
|
3
|
Dulin M, Pasi N, Benali K, Ducrocq G, Roriz M, Pellenc Q, Para M, Chauveheid MP, Goulenok T, van Gysel D, Dossier A, Papo T, Sacre K. Management of patients with myocardial tuberculosis: A case series. Int J Cardiol 2020; 327:132-137. [PMID: 33166586 DOI: 10.1016/j.ijcard.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Myocardial Tuberculosis (MT) is exceedingly rare. We aimed to report on myocardial involvement in tuberculosis (TB). METHODS All adult patients admitted in a department of Internal Medicine over an 8-year period with microbiologically proven MT were retrospectively reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. RESULTS Six patients (4 women, 37.6 [21.3-62.1] years) with MT were identified. MT included cardiac mass (n = 1), coronaritis (n = 1), left ventricle spontaneous rupture (n = 1) and myocarditis (n = 3). Pericardial effusion was associated with myocardial involvement in 2 cases. Four patients presented with acute heart failure. CRP serum level was high in all cases. The mean delay between the first symptoms and TB diagnosis was of 6 [1-44] months. The time from admission to diagnosis was of 18 (9-28) days. No patient had human immunodeficiency virus infection. Fluorodeoxyglucose - positron emission tomography (FDG-PET) detected extra-cardiac asymptomatic Mycobacterium tuberculosis infection localization and guided biopsy in 5 cases. As compared to TB patients without cardiac involvement, patients with MT were younger and more frequently women. All patients received antituberculosis therapy for 7.5 to 12 months associated with steroids for at least 6 weeks. Cardiac surgery was required in all but one patient. No patient died over a median follow-up of 1.2 [0.2-4.4] years. CONCLUSION Our study emphasizes the clinical spectrum of life-threatening MT. Early diagnosis using FDG-PET imaging to target biopsy in extra-cardiac tissues and combined treatment strategy associating antituberculosis therapy, corticosteroids and surgery prevent complications and death.
Collapse
Affiliation(s)
- Marie Dulin
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicoletta Pasi
- Département de Radiologie, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Khadija Benali
- Département de Médecine Nucléaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mélanie Roriz
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Quentin Pellenc
- Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marylou Para
- Département de Chirurgie Cardio-vasculaire, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie-Paule Chauveheid
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Damien van Gysel
- Département d'Information Médicale, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France.
| |
Collapse
|
4
|
Razzano D, Fallon JT. Myocarditis: somethings old and something new. Cardiovasc Pathol 2019; 44:107155. [PMID: 31760237 DOI: 10.1016/j.carpath.2019.107155] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022] Open
Abstract
"Since the pathological conditions take place at the cellular level, viral myocarditis and postinfectious autoimmunity can be suggested but not diagnosed clinically. All clinical methods including imaging techniques are misleading if infectious agents are involved. Accurate diagnosis demands simultaneous histologic, immunohistochemical, and molecular biological workup of the tissue. If the primary infectious or immune-mediated causes of the disease are carefully defined by clinical and biopsy-based tools, specific antiviral treatment options in addition to basic symptomatic therapy are available under certain conditions. These may allow a tailored cause-specific treatment that improves symptoms and prognosis of patients with acute and chronic disease." Uwe Kühl; Heinz-Peter SchultheissViral myocarditis.Swiss Medical Weekly. 144():w14010, JAN 2014 DOI:10.4414/smw.2014.14010.
Collapse
Affiliation(s)
- Dana Razzano
- New York Medical College at Westchester Medical Center, Valhalla, NY, 10595, USA.
| | | |
Collapse
|
5
|
Awasthy N, Garg R, Goel A, Bhatia M, Radhakrishnan S. Ventricular arrhythmia: A feature of tubercular myocarditis. Ann Pediatr Cardiol 2019; 12:53-55. [PMID: 30745771 PMCID: PMC6343378 DOI: 10.4103/apc.apc_123_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tuberculat myocarditis is an extremely rare entity with few published reports. We report a 13 year old male who presented with ventriculat tachycardia. On evaluation he was observed to have MRI features and workup consistent with nodular variant of tubercular myocarditis. Child had fatal outcome on follow up.
Collapse
Affiliation(s)
- Neeraj Awasthy
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Riya Garg
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Apoorav Goel
- Department of Radiology, Atulya Healthcare, New Delhi, India
| | - Mona Bhatia
- Department of Radiology, Fortis Escorts Heart Institute, New Delhi, India
| | - S Radhakrishnan
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| |
Collapse
|
6
|
Chinen K, Ito K. Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis. AUTOPSY AND CASE REPORTS 2019; 9:e2018059. [PMID: 30863732 PMCID: PMC6394360 DOI: 10.4322/acr.2018.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 12/26/2022] Open
Abstract
An 84-year-old Japanese woman with myelodysplastic syndrome was admitted with pyrexia and dyspnea, but died suddenly during diagnostic evaluation. The autopsy revealed miliary tuberculosis in addition to myelodysplastic syndrome in the bone marrow. The immediate cause of the patient’s sudden death was pulmonary fat embolism derived from bone marrow necrosis. This case shows that the infiltration of the myelodysplastic bone marrow by tuberculosis and consequent bone marrow necrosis and fat embolism can be the cause of sudden death. In this article, we report the autopsy results of this unusual cause of sudden death, and discuss tuberculosis-related sudden death with a review of the literature.
Collapse
Affiliation(s)
- Katsuya Chinen
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
| | - Kashima Ito
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
| |
Collapse
|
7
|
Kruger MM, Martin LJ, Maistry S, Heathfield LJ. A systematic review exploring the relationship between infection and sudden unexpected death between 2000 and 2016: A forensic perspective. Forensic Sci Int 2018; 289:108-119. [PMID: 29860163 DOI: 10.1016/j.forsciint.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
Death due to infectious diseases is a major health concern worldwide. This is of particular concern in developing countries where poor-socio economic status and a lack of healthcare resources contribute to the high burden of disease. In some cases death due to infection can be acute and aggressive, and death may occur without a diagnosis whilst the person is still alive. These deaths may ultimately lead to a medico-legal autopsy being performed. There are various mechanisms by which sudden death due to infection may occur. In addition, there are many risk factors associated with sudden death due to infection, which differ between infants and older individuals. However, it is unclear which pathogens and risk factors are most frequently associated with sudden death due to infection. Therefore a systematic review of articles and case reports published between 1 January 2000 and 30 June 2016 was undertaken in order to (1) explore the relationship between pathogens and their causative role and (2) identify the relationship between predisposing and/or risk factors associated with sudden death due to infection. Major databases were searched and after critical appraisal 143 articles were identified. It was found that respiratory infections and deaths involving bacterial pathogens were most commonly associated with these deaths. In addition the most common risk factors in infants were exposure to tobacco smoke and co-sleeping. In adults the most common risk factors were co-morbid conditions and illnesses. This information aids in a better understanding of these deaths and highlights the need for more research in this field, particularly in developing countries.
Collapse
Affiliation(s)
- Mia M Kruger
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Lorna J Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Sairita Maistry
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| | - Laura J Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
| |
Collapse
|
8
|
Lambatten D, Hammi S, Rhofir Y, Bourkadi JE. [Myocardial tuberculoma: unusual location of tuberculosis: a new observation and review of the literature]. Pan Afr Med J 2016; 24:32. [PMID: 27583096 PMCID: PMC4992366 DOI: 10.11604/pamj.2016.24.32.9361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/03/2016] [Indexed: 11/18/2022] Open
Abstract
Nous rapportons l'observation d'un patient de 50 ans présentant une masse tumorale du ventricule gauche évoluant dans un contexte d'altération de l’état général et de fièvre. Cette masse a été objectivée par l’échocardiographie réalisée pour l'exploration d'une cardiomégalie radiologique. L'aspect en imagerie par résonance magnétique était évocateur d'un tuberculome intra myocardique. A travers notre observation, nous proposons une revue de la littérature sur cette localisation inhabituelle de la tuberculose.
Collapse
Affiliation(s)
- Dalal Lambatten
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Sanaa Hammi
- Faculté de Médecine et de Pharmacie de Tanger, Maroc
| | - Yasmina Rhofir
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Jamal Eddine Bourkadi
- Service de Pneumo-Phtisiologie, Hospital Moulay Youssef, CHU Rabat, Akkari, 10000, Maroc; Faculté de Médecine et de Pharmacie de Rabat, Maroc
| |
Collapse
|
9
|
du Toit-Prinsloo L, Saayman G. “Death at the wheel” due to tuberculosis of the myocardium: a case report. Cardiovasc Pathol 2016; 25:271-274. [DOI: 10.1016/j.carpath.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022] Open
|
10
|
Michira BN, Alkizim FO, Matheka DM. Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases. Pan Afr Med J 2015; 21:118. [PMID: 26327955 PMCID: PMC4546727 DOI: 10.11604/pamj.2015.21.118.4282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 02/03/2015] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the ‘young’ patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.
Collapse
Affiliation(s)
| | - Faraj Omar Alkizim
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
| | - Duncan Mwangangi Matheka
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
| |
Collapse
|
11
|
Liu A, Nicol E, Hu Y, Coates A. Tuberculous Endocarditis. Int J Cardiol 2013; 167:640-5. [DOI: 10.1016/j.ijcard.2012.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/11/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
|
12
|
Desai N, Desai S, Chaddha U, Gable B. Tuberculous myopericarditis: a rare presentation in an immunocompetent host. BMJ Case Rep 2013; 2013:bcr-2012-007749. [PMID: 23456155 DOI: 10.1136/bcr-2012-007749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis is a common cause of pericardial disease in India. Myocardial involvement, although well described in the literature, is a rare manifestation of tuberculosis. We report a patient with disseminated tuberculosis and myopericarditis manifesting as cardiogenic shock. The patient gradually improved on antituberculosis drug therapy, steroids and an evidence-based guideline driven therapy for heart failure. Follow-up imaging showed calcification of the pericardium and improvement of his left ventricular systolic function.
Collapse
Affiliation(s)
- Nayan Desai
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA.
| | | | | | | |
Collapse
|
13
|
Liu A, Hu Y, Coates A. Sudden cardiac death and tuberculosis – How much do we know? Tuberculosis (Edinb) 2012; 92:307-13. [DOI: 10.1016/j.tube.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/07/2012] [Indexed: 12/13/2022]
|
14
|
Rodríguez Y, de Armas Y, Capó V, Wissmann G, Goldani LZ, De Waard JH. Sudden death related to tuberculous coronary arteritis. Int J Cardiol 2011; 156:e28-9. [PMID: 21880380 DOI: 10.1016/j.ijcard.2011.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/03/2011] [Indexed: 11/24/2022]
|
15
|
Abstract
The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death. Many of the causes of sudden death are due to genetic heart disorders, which can lead to both structural (eg, hypertrophic cardiomyopathy) and arrhythmogenic abnormalities (eg, familial long QT syndrome, Brugada syndrome). Most commonly, sudden cardiac death can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a great challenge to the forensic pathologist involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counselor, and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological, and social complexities observed in families in which there has been a young sudden cardiac death. The present study will address the spectrum of structural substrates of cardiac sudden death with particular emphasis given to the possible role of forensic molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability.
Collapse
|
16
|
Mteirek M, Beuret P, Convert G. [Tubercular myocarditis: two case reports and review of the literature]. Ann Cardiol Angeiol (Paris) 2011; 60:105-108. [PMID: 21277559 DOI: 10.1016/j.ancard.2010.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/24/2010] [Indexed: 05/30/2023]
Abstract
We report here the cases of two patients developing tubercular myocarditis with a different clinical presentation, the first one with a myopericarditis, the second one presenting as pseudo-infarction complicated by cardiogenic shock. We discuss here the different anatomical and clinical presentations, the diagnostic approach, the indications of myocardic biopsy and the prognosis of this pathology.
Collapse
MESH Headings
- Adult
- Antitubercular Agents/therapeutic use
- Biopsy
- Diagnosis, Differential
- Female
- Humans
- Mycobacterium tuberculosis/isolation & purification
- Myocardial Infarction/diagnosis
- Myocarditis/diagnosis
- Myocarditis/drug therapy
- Myocarditis/microbiology
- Myocardium/pathology
- Pericarditis, Tuberculous/diagnosis
- Prognosis
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/drug therapy
- Shock, Cardiogenic/microbiology
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/drug therapy
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
Collapse
Affiliation(s)
- M Mteirek
- Service de cardiologie, CHG de Roanne, France.
| | | | | |
Collapse
|
17
|
Matejic D, Schönfeld C, Tsokos M. Plötzlicher Tod bei akuter idiopathischer Riesenzellmyokarditis. Rechtsmedizin (Berl) 2010. [DOI: 10.1007/s00194-010-0686-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
18
|
Brar R, Prasad A, Kumar A, Bagai M, Malhotra M. Myocardial tuberculosis presenting with congestive heart failure and pulmonary venous occlusion. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
19
|
Bhagavath P, Rastogi P, Menezes RG, Valiathan M, Mohan Kumar T, Raghavendra Babu Y, Kanchan T, Monteiro FN, Nayak VC. Sudden death due to pulmonary aspergillosis. J Forensic Leg Med 2009; 16:27-30. [DOI: 10.1016/j.jflm.2008.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 03/26/2008] [Accepted: 05/18/2008] [Indexed: 11/29/2022]
|
20
|
|
21
|
|
22
|
Mohd Shah AS, Sulaiman MD, Saidin N, Maskon O. Fatal perimyocarditis in a migrant worker to the tropics from an unexpected aetiology: a case report. J Clin Pathol 2008; 60:1180-1. [PMID: 17906072 PMCID: PMC2014837 DOI: 10.1136/jcp.2006.044503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Khurana R, Shalhoub J, Verma A, Assomull R, Prasad SK, Kooner JS, Sethi A. Tubercular myocarditis presenting with ventricular tachycardia. ACTA ACUST UNITED AC 2008; 5:169-74. [DOI: 10.1038/ncpcardio1111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 11/14/2007] [Indexed: 11/09/2022]
|
24
|
Abstract
Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.
Collapse
Affiliation(s)
- Rebecca A Hamilton
- Office of the District 21 Medical Examiner, 70 Danley Drive, Fort Myers, FL 33907, USA.
| | | | | |
Collapse
|
25
|
Biedrzycki OJ, Baithun SI. TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature. Am J Forensic Med Pathol 2007; 27:335-6. [PMID: 17133033 DOI: 10.1097/01.paf.0000233633.16185.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
TB-related sudden death (TBRSD) is rarely reported in the literature and in the majority of cases is due to bronchopneumonia and hemoptysis. Cardiac complications of tuberculosis causing sudden death can take many forms and are rarer still, with only a handful of cases reported. We describe a case of a previously fit and healthy 20-year-old Asian female who, after returning from a holiday in India, collapsed while getting off a bus. At postmortem, the only macroscopic finding of note was a localized area of fibrosis on the anterior wall of the left ventricle. Microscopic examination of this area showed Langhans giant cells; noncaseating epithelioid granulomas and acid-fast bacilli were demonstrated on Ziehl Nielsen staining. In addition, the lungs, liver, and kidneys contained multiple noncaseating granulomas. The case serves to highlight the protean nature in the presentation of this disease and the importance of postmortem histology in autopsy work.
Collapse
Affiliation(s)
- O J Biedrzycki
- Division of Cellular Pathology, The Royal London Hospital, Stepney Way, Whitechapel, England.
| | | |
Collapse
|
26
|
Menon A, Rastogi P, Khadilkar U. Sudden death due to tuberculosis. J Forensic Leg Med 2006; 14:228-30. [PMID: 17052944 DOI: 10.1016/j.jcfm.2006.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 06/14/2006] [Indexed: 11/30/2022]
Abstract
Forensic pathologists deal not only with criminal, accidental and suicidal deaths, but also with a wide range of deaths from natural causes. Many of these deaths are sudden, unexpected, clinically unexplained or obscure, even though there need be no criminal element in their causation. Unnatural deaths have always to be investigated by the police, but very often natural deaths forms the basis of medico legal investigation, if they had occurred suddenly in apparently healthy persons. Often at autopsy these so called unnatural deaths may turn out to be natural and vice versa. Two cases of sudden death occurring in young individuals under suspicious circumstances are presented. On autopsy they were diagnosed to be secondary to tuberculosis.
Collapse
Affiliation(s)
- Anand Menon
- Department of Forensic Medicine, Kasturba Medical College, Mangalore, India.
| | | | | |
Collapse
|
27
|
Abstract
Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.
Collapse
Affiliation(s)
- Enrico Silingardi
- Institute of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | | | | | | |
Collapse
|
28
|
Ruiz-Giménez Arrieta N, Hurtado J, Sánchez E, Sanz J. Tuberculosis miliar con afectación miocárdica. Med Clin (Barc) 2006; 126:278. [PMID: 16510072 DOI: 10.1157/13085285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
29
|
Batalis NI, Harley RA, Collins KA. Iatrogenic Deaths Following Treatment for Hypertrophic Obstructive Cardiomyopathy. Am J Forensic Med Pathol 2005; 26:343-8. [PMID: 16304468 DOI: 10.1097/01.paf.0000188096.28402.c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a disease process which results in a large, heavy heart, with hypertrophy of the interventricular septum (IVS) and left ventricle. HCM accounts for a significant number of cases of sudden cardiac death each year, most infamously in young athletes. The prevalence of the disease has increased over the past several years due to advances in clinical diagnosis and molecular genetic studies. Over this same period, new forms of treatment also have emerged. One such treatment is alcohol septal ablation (ASA). ASA is a procedure performed by a cardiologist, via cardiac catheterization, by injecting pure ethanol into selected arteries which supply the IVS, resulting in a targeted myocardial infarction. This infarct then retracts and forms a scar, decreasing the outflow obstruction and improving the patient's clinical symptoms.The authors report 2 cases of death following ASA treatment of HCM. The first, a 56-year-old male, had his ASA procedure 10 days prior to death. The second decedent, a 76-year-old female, had her procedure only 30 hours before death. These case reports are followed by a discussion about HCM, including pathology, treatments, and treatment-related pathology, before closing with a discussion about death certification in the cases presented and therapy-related deaths in general.
Collapse
Affiliation(s)
- Nick I Batalis
- Medical University of South Carolina, Forensic Pathology Section, Charleston, 29412, USA.
| | | | | |
Collapse
|
30
|
Abstract
INTRODUCTION Tuberculosis can be responsible for myocardial damage, the frequency of which is probably underestimated because of the difficulty in its diagnosis. We studied the contribution of cardiac magnetic resonance imaging (MRI) in three patients. OBSERVATIONS Three patients were treated for disseminated tuberculosis. They had moderate cardiac abnormalities (tachycardia, dyspnoea on effort). The electrocardiogram was normal in 2 patients and the echocardiography showed localized hyperkinesias. Cardiac MRI revealed intra-myocardial nodular gadolinium enhancement and hyperkinesias. The clinical outcome in the 3 patients was favourable following anti-tuberculosis therapy; one patient was also administered corticosteroids. DISCUSSION Cardiac MRI is a non-invasive examination that brought important arguments for the diagnosis of tubercular myocarditis in the 3 patients.
Collapse
Affiliation(s)
- Guillaume Breton
- Service des maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France
| | | | | | | | | | | |
Collapse
|
31
|
Tuberculosis of the Heart and Pericardium. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|