Intracardiac Tuberculoma in the Immunocompromised Population – A review

Abstract

PurposeTo understand the peculiar factors which guide the diagnosis of intracardiac tuberculoma especially in sick children with altered immunity.MethodLiterature review of scientific papers in Med‐line/Pub Med, and other popular search engines.ResultsTuberculosis (TB) is a contagious airborne disease. WHO ranks TB alongside HIV/AIDS as a leading cause of death worldwide. [1] At least one‐third of people living with HIV worldwide in 2014 were infected with TB bacteria. HIV patients are 20 to 30 times more likely to develop active TB disease. It is estimated that pediatric cases account for 10–15% of the global TB. Majority of them occur in infants and children under 5 years of age. [2] Diagnosis of TB in children is more difficult than in adults, because few signs are associated with primary infection, interferon‐gamma release assays (IGRA) and tuberculin skin test (TST) are less reliable in younger children.[3] In the pediatric age, the prodromal stage is often very short, and the risk of progression to active disease is higher (30–40% in those younger than 1 year of age) and children (24% in 1–5 years of age) compared to the subsequent ages if treatment is inadequate. Following the inhalation of mycobacteria, innate immunity controls infection in immune‐competent patients. [3] Children are prone to develop extra‐pulmonary TB; about 4% of children infected under the age of 5 years, develop tubercular meningitis or miliary TB. [4] Cardiac tuberculosis is usually found at postmortem examination. Endocardial tuberculoma is extremely rare, found in only 0.14% of autopsy cases. Studies carried out before the introduction of specific anti‐tuberculous therapy assert that the myocardium is involved in less than 0.30% of patients dying of tuberculosis. [5] The myocardium might be affected by direct spread from the mediastinal gland, by the lymphatic routes, or the bloodstream. Organ involvement with M. tuberculosis infection was classified as being miliary or nodular. Nodular myocardial tuberculosis might develop into a ventricular aneurysm. [6] A tuberculoma is a clinical manifestation of tuberculosis which conglomerates tubercles into a firm lump, and so can mimic cancer tumors of many types in medical imaging studies. [7] Since these are evolutions of primary complex, the tuberculomas may contain within caseum or calcification. They can affect any organ such as the brain, intestines, ovaries, breast, lungs, esophagus, liver, pancrease, bones, the heart and many others. As the histological and clinical indications, as well as tumor markers such as CA‐125, are similar, it is often difficult to differentiate tuberculoma from cancer. For these reasons, tuberculosis should always be considered in differential diagnosis of cancer. [8] Intracardiac tuberculomas may be localized at any part of the heart. They were found at the proximal superior vena cava and the right atrium in a 17year old male patient initially diagnosed as angiosarcoma or rhabdomyosarcoma. [9] “Clinically, tuberculomas may be asymptomatic or may present with arrhythmias, complete heart block, congestive heart failure, superior vena caval obstruction, right ventricular outflow obstruction, aortic insufficiency and sudden cardiac death”. [11]ConclusionsIntracardiac tuberculoma is a rare finding, often diagnosed in patients with miliary tuberculosis. The increased prevalence of HIV/AIDS and other immunosuppressive conditions lead to their emergence among infants and adults with tuberculosis.Support or Funding InformationAPS Minority Travel Award (applied)This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.