A rare manifestation of extrapulmonary tuberculosis: left ventricular cardiac tuberculoma in an HIV infected male "case report"

Cardiac tuberculosis (TB) is rare and most commonly manifests itself as tuberculous pericarditis. Involvement of other parts of the heart is unusual and descriptions in the literature are confined to case reports regarding mainly pericardial TB and very few cases of cardiac tuberculoma. Tuberculomas are space occupying lesions most commonly found in the brain of immunocompromised individuals. These space occupying lesions previously described only after autopsies are now more diagnosed with the use of advanced imaging techniques. Herein, we describe a first case of pericardial TB manifesting as left ventricular (LV) cardiac tuberculoma in a 34-year-old human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infected male. Upon presentation the patient complained mainly of progressive dyspnoea over the past month. Primary investigations including chest computed tomography (CT) scan and transthoracic echocardiography (TTE) suggested probable diagnosis of cardiac and pericardial TB which was later confirmed by histopathological modalities. The patient received anti-TB therapy along with surgical subtotal pericardiotomy which resulted in improvement of symptoms, complete resolution of the mass and reduction in the size of pericardial thickening. Although very rare it is crucial to bear in mind the importance of having cardiac tuberculoma as differential diagnosis in patients with a cardiac mass and implement the optimum diagnostic and therapeutic courses.