Intracardiac left atrial tuberculoma in an eleven-month-old infant: case report

We describe a case of pulmonary miliary tuberculosis associated with intracardiac left atrial tuberculoma in an immunocompetent eleven-month-old infant successfully treated with surgery and antituberculous therapy.Although unusual, involvement of endocardium in disseminated tuberculosis should be kept in mind.Tuberculosis (TB) is one of the top ten causes of death among children worldwide and it is a direct consequence of adult TB [1]. In the natural history of childhood pulmonary TB, primary infection before two years of age frequently progresses to disease within twelve months [2]. Young age and human immunodeficiency virus type 1 (HIV-1) infection are the most important risk factors for severe or disseminated disease [2,3]. The involvement of the heart in TB is a very rare clinical condition both in adults and children [4,5]. We report here a case of pulmonary miliary TB associated with intracardiac left atrial tuberculoma in an eleven-month-old infant successfully treated with surgery and antituberculous therapy.An eleven-month-old female infant was referred to her local hospital for a 2-week history of intermittent fever, cough, dyspnea, night sweats and poor feeding. She was initially treated with amoxicillin-clavulanic acid for presumed upper respiratory tract infection without improvement.On examination, she was underweight for age, had a temperature of 37.5°C, pulse was regular with a rate of 130 beats per minute, blood pressure was normal, transcutaneous oxygen saturation was 96% on room air, and respiration rate was 40 breaths per minute. A few crackles were heard bilaterally and a mild systolic murmur was noted. She had soft, mobile, non tender, small volume cervical lymph nodes with normal overlying skin and no evidence of discharge. The rest of the clinical examination was unremarkable. A complete blood count at presentation revealed a hemoglobin of 10.4 mg/dL, white cell count of 18 × 103 cell/μL with neutrophilia, and a platelet count of 660 × 103cel