An unusual case of mycobacterium tuberculous coronary arteritis and thrombosis resulting in acute myocardial infarction

Abstract

Tuberculosis (TB) is a prevalent infection worldwide and an endemic infection in Singapore. The most common presentation is that of pulmonary tuberculosis. Extra pulmonary tuberculosis usually involves the lymph nodes, pleura, central nervous system, or abdominal cavity. Involvement of the heart is rare (0.14-2% of TB cases), and when it is involved, it tends to be in the pericardium or myocardium. Here, a rare case of sudden death due to tuberculous coronary arteritis with tuberculous coronary thrombosis resulting in acute myocardial infarction is presented.

The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis

“…Likewise, patients with TB have an increased risk of ischemic 9 , 10 , but not hemorrhagic stroke in the first three years after TB diagnosis 10 when compared to non-infected controls. Multiples cases of TB causing coronary arteritis and subsequent AMI have been reported 40 , 41 . Preclinical studies have shown that mycobacterial infection aggravates atherosclerosis formation in the aortas of hyperlipidemic, lipoprotein receptor knockout ( Ldlr −/− ) mice 42 .…”

Coronary arteritis as a cause of sudden cardiac death in a young girl

“…3 The heart is involved only in 0.14-2% of all the TB cases, and it tends to affect the pericardium or the myocardium primarily. 7 TB myocarditis was first reported in 1664 by Maurocordat. 8 Cardiac TB can be morphologically categorized into three types: diffuse infiltrative, miliary, and tuberculomas.…”

“…8 Cardiac TB can be morphologically categorized into three types: diffuse infiltrative, miliary, and tuberculomas. 7 Rose et al 5 did an extensive study on 19 cases of cardiac TB, and every case demonstrated either miliary or systemic TB. The authors were convinced with three possible routes of spread to the myocardium: directly from the pleural cavity or the pericardium, spread from lymph nodes, and hematogenous dissemination.…”

“…9 However, tuberculous mediastinal lymphadenitis is also believed to be the cause of direct spread into the myocardium, from where it can involve the coronary arteries. 7 Generally, the inflammation in the surrounding tissue tends to extend into the adventitial layer, morphologically seen as edema, mononuclear infiltrate and/or granulation tissue, and this further can spread till the intima. 10 Fong et al 11 found that the mycobacteria directly invade the blood vessels of the heart leading to an autoimmune reaction and subsequently thrombosis.…”

The Association of Atherosclerotic Cardiovascular Disease and Statin Use With Inflammation and Treatment Outcomes in Tuberculosis

“…Likewise, patients with TB have an increased risk of ischemic 9,10 , but not hemorrhagic stroke in the rst three years after TB diagnosis 10 when compared to non-infected controls. Multiples cases of TB causing coronary arteritis and subsequent AMI have been reported 33,34 . Preclinical studies have shown that mycobacterial infection aggravates atherosclerosis formation in the aortas of hyperlipidemic, lipoprotein receptor knockout (Ldlr -/-) mice.…”