Abstract
1. Case report A 38-year-old woman was admitted in the emergency services department in a gasping state. She had developed progressive dyspnea, orthopnea, bluish discoloration of finger tips, mild fever, dry cough with streaky hemoptysis, and jaundice in the past 4 days. She had a previous admission 1 month back for low-grade intermittent fever and Grade II dyspnea. A two-dimensional echocardiography then revealed minimal pericardial effusion and global hypokinesia suggestive of dilated cardiomyopathy. The patient died within 4 h of admission. At autopsy, the subject’s heart appeared massively enlarged and weighed 470 g. There was extreme thickening of both layers of the pericardium, enclosing confluent foci of creamy caseous material. These were prominently seen over various grooves and the left ventricular apex. However, at the anterior and lateral surfaces of the right atrium, the caseation had a thickness of 3 cm. It had infiltrated the atrial wall to produce three smooth-surfaced, broad-based polypoidal masses, tuberculomas (Fig. 1) that had almost obliterated the atrial cavity. The epicardial coronary arteries were surrounded by caseation but were patent. Few acid-fast bacilli could be demonstrated in the air-dried smears. The left ventricle was small. Microscopically, the areas of caseation were surrounded by the typical granulomatous reaction. In addition, there were tuberculous bronchopneumonia and lymphadenitis with miliary granulomas in the liver, spleen, and bone marrow and hemorrhagic hepatic necroses. No bacillus was demonstrated in the tissue sections. No culture was done.
Published Version
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