Tuberculosis (TB) is usually clinically confined to the respiratory system; however, it can affect any organ.
Cardiac tuberculosis, though, is a rare as extrapulmonary manifestation of TB, generally it is clinically silent, and it shows up as sudden death due to ventricular arrhythmias.
TB, and in particular cardiac TB, is a disease with complex signs and symptoms that overlap with other disorders determining a diagnostic dilemma, especially in case of a blood culture-negative infective pancarditis.
Herein we report a case of a 30-year-old patient (African immigrant, HIV negative, black) who presented with chest pain and heart pounding because of paroxysmal atrial fibrillation. He suddenly developed sustained ventricular tachycardia, for which he was underwent subcutaneous ICD implantation.
He was submitted to echocardiography and magnetic resonance, and a large mass involving right atrium, right ventricle and apex was observed.
Cardiac tuberculosis without active pulmonary disease, with a concomitant spondylodiscitis, was diagnosed thanks to bacterial cultures of specimens drained from vertebral abscesses.
After Mycobacterium Bovis was isolated, the patient received anti-tubercular therapy with wide improvement
of symptoms and neat reduction of the cardiac mass observed in months at echocardiographic follow – up.
Although literature describes high rate of mortality and complications due to cardiac tuberculosis a favourable outcome occurred.