Imaging insights into systemic tuberculosis with cardiac involvement: A rare challenging case of tuberculous chronic constrictive pericarditis and myocarditis

Abstract

Tuberculosis (TB) is a major public health challenge, primarily affecting the lungs. However, it can disseminate to any organ system, including the cardiovascular system. Among cardiac structures, the pericardium is the most commonly affected, often leading to constrictive pericarditis, whereas myocarditis remains rare. The clinical presentation of cardiac TB is heterogeneous and is frequently associated with extra cardiac manifestations, complicating the diagnostic process, particularly in the absence of definitive microbiological confirmation. In this context, advanced multimodal imaging is essential to improve diagnostic accuracy. We present a complex case of systemic TB manifesting as chronic constrictive pericarditis, myocarditis, pleuritis, chorioretinitis, and spondylodiscitis with a psoas abscess. A 21-year-old patient was admitted with dyspnea, acute chest pain, progressive vision declines and persistent lower back pain. Imaging, notably cardiac magnetic resonance, strongly suggested myopericardial TB associated with systemic involvement. Nonetheless, microbiological and histopathological tests for TB were negative. Given the high clinical suspicion of TB and the lack of other plausible causes, anti-tuberculous therapy was initiated along with corticosteroids and heart failure regimen. Pericardiectomy was subsequently performed. The patient demonstrated significant improvement within 6 weeks, further supporting the diagnosis of TB. Considering the potentially life-threatening complications of cardiac TB, a high index of clinical suspicion, along with a comprehensive multimodal imaging approach, is essential for early diagnosis, timely intervention, and improved patient outcomes.