Ventricular Arrhythmia as a Presenting Feature in a Patient With Tubercular Myocarditis and Axillary Lymphadenopathy

Background There are very few case studies of tuberculosis (TB)-associated myocarditis published. Case summary We present a case of a girl in her late adolescence, who presented with ventricular tachycardia. Multimodality imaging with 2D echocardiogram and cardiac magnetic resonance revealed an ejection fraction of 25%, global left ventricular hypokinesia, and moderate mitral regurgitation. Holter monitoring detected nonsustained ventricular tachycardia with varying morphology. Fluorodeoxyglucose positron emission tomography and biopsy confirmed granulomatous lymphadenitis, secondary to TB. The patient was started on guideline-directed medical therapy for heart failure and anti-TB treatment, which led to resolution of ventricular tachycardia and improvement of symptoms and left ventricular ejection fraction. Discussion A case report of myocarditis related to TB takes significance due to India's significant TB burden. While pulmonary TB is the most common presentation, cardiac involvement is often neglected leading to delayed diagnosis and treatment. Take-home message Highlighting atypical presentations such as TB-induced cardiomyopathy can enhance diagnostic vigilance.