Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas

• Main Authors: Z. Farah, V.E. Beasley, M. Berry, R.K. Coker, O.M. Kon
• Format: Article
• Language: English
• Published: Elsevier 2014-01-01
• Series: Respiratory Medicine Case Reports
• Subjects: Tuberculosis; Arrhythmias; Endobronchial ultrasound; Cardiology arrhythmia-therapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213007113000415

Tuberculosis is a leading cause of death worldwide. It affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. In this report, we describe two cases in which TB causes myopericarditis and presents with a broad-complex tachycardia that did not respond typically to standard anti-arrhythmic therapy; a very rare presentation with limited description in the literature. Both patients required extensive investigation culminating in identifying lymph nodes amenable to biopsy under endobronchial ultrasound guidance. It was not until both patients received anti-tuberculous chemotherapy alongside anti-arrhythmic management that any improvement to their condition was witnessed. Therefore, we recommend that the clinician should have a high index of suspicion for TB in any patient presenting with a broad-complex tachycardia that is not responding to standard first line management, especially if the patient is from a high risk background. We recommend an active diagnostic pursuit, and lymph node biopsy under endobronchial ultrasound guidance.