The great masquerade: TB endomyocarditis as left ventricular mass

Abstract

Cardiac masses are rare and often diagnosed via imaging due to difficulties in obtaining tissue samples. This case highlights an unusual presentation of tuberculosis (TB) endomyocarditis as a left ventricular mass. A 25-year-old male presented with intermittent fever, chills, atypical chest pain, and weight loss over 6 months, with no other cardiac symptoms or TB exposure. Imaging revealed a left ventricular mass (5 × 4 × 2 cm) with a high standardised uptake value (SUV) of 28 and mediastinal lymph nodes with an SUV of 8, raising suspicions of sarcoma or lymphoma. After multidisciplinary evaluation, the patient underwent three cycles of ifosfamide and epirubicin, but the mass did not decrease in size. A biopsy showed necrotising abscesses and epithelioid cell granulomas, but no atypical cells, ruling out malignancy. A positive tuberculin test prompted initiation of intensive anti-tubercular treatment (HRZE). Two months later, follow-up magnetic resonance imaging (MRI) indicated a reduction in mass size by over 90%. This case illustrates a rare instance of primary intracardiac tubercular endomyocarditis and emphasizes the need to consider TB in atypical cardiac masses. The patient continues anti-tubercular therapy and is under follow-up.

Keywords: Endo-myocarditis; Left ventricular mass; Tuberculosis (TB).