A patient with Tuberculous para-valvular leak and tuberculous hepatic abscesses treated conservatively with anti-tuberculous medication without the need for surgical intervention. “Case report”

Introduction: We report a case of a young lady with rheumatic heart disease who underwent mechanical prosthetic mitral valve replacement and tricuspid valve repair. The case was complicated after one year by multi system tuberculous abscesses, para-valvular leak and hemolytic anemia. Case summary: The case started one year following mechanical prosthetic mitral valve replacement, and after contact with a tuberculous patient. The lady developed, sterile pyuria, two tuberculous hepatic abscesses, and a big pelvic tuberculous abscess. She first needed percutaneous drainage for the pelvic abscess followed by laparotomy and surgical drainage after recurrence. The case was complicated by Para-valvular leak in the prosthetic mitral valve detected by Transoesophageal echocardiography as well as refractory hemolytic anemia needing multiple transfusions. She required six months of anti-tuberculous therapy for the hemolysis to stop. Treatment continued for a total of one year of anti-tuberculous therapy. The patient restored normal valve dynamics and hematological parameters without the need for surgical intervention for the para-valvular leak. Conclusion: We report this case to show that small tuberculous para-valvular leak and hemolytic anemia as well as tuberculous hepatic abscesses can be treated medically as an alternative option to the well-known and recommended surgical indication. We also confirm delayed healing of the abdominal surgical wound due to tuberculosis.