# Rare Coexistence of Cardiac Tuberculosis: Effusive-Constrictive Pericarditis With Right Atrial Tuberculoma and Right Atrial Myocarditis in an Immunocompetent Patient With Disseminated Tuberculosis

## TL;DR

A 22-year-old immunocompetent man with disseminated tuberculosis had a rare combination of heart conditions, including pericarditis, a tuberculoma, and myocarditis, diagnosed through imaging and surgery.

## Contribution

This is the first documented case of effusive-constrictive pericarditis, right atrial tuberculoma, and right atrial myocarditis coexisting in an immunocompetent TB patient.

## Key findings

- The patient's diagnosis was confirmed using echocardiography, CT scan, and histopathological analysis.
- Histopathology confirmed right atrial tuberculoma and myocarditis after microbiological tests were inconclusive.
- The patient responded well to anti-tubercular therapy and surgical resection.

## Abstract

Cardiac involvement in tuberculosis (TB) is uncommon, and especially the concurrent occurrence of effusive-constrictive pericarditis, right atrial tuberculoma, and right atrial myocarditis is extremely rare in immunocompetent individuals. We report a case of a 22-year-old immunocompetent male with disseminated TB, presenting with this rare combination. To our knowledge, this specific coexistence has not been documented in the literature previously. The diagnosis was confirmed using 2D echocardiography, CT scan, and histopathological analysis. Echocardiography revealed pericardial effusion and signs of constrictive pericarditis, supported by respiratory variation in ventricular filling. These findings were also consistent with the patient’s clinical presentation. The right atrial tuberculoma was confirmed by histopathology of the resected tissue, and right atrial myocarditis was also proven histologically. The patient was treated with standard anti-tubercular therapy and underwent surgical resection for right atrial tuberculoma, with a favorable clinical outcome. This case also highlights the diagnostic value of histopathology when microbiological tests are inconclusive and emphasizes the need to consider TB in the differential diagnosis of cardiac masses, which can mimic various neoplastic or thrombotic lesions.