Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 11-12, Pages: 645-649
https://doi.org/10.2298/SARH1612645P
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Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report
Pešut Dragica P. (School of Medicine, Belgrade + Clinical Center of Serbia, Hospital for Pulmonology, Belgrade)
Petrović Milan Ž. (School of Medicine, Belgrade + Clinical Center of Serbia, Hospital for Cardiology, Belgrade)
Vasić Nada R. (Clinical Center of Serbia, Hospital for Pulmonology, Belgrade)
Stević Ruža S. (School of Medicine, Belgrade + Clinical Center of Serbia, Center for Radiology and Magnetic Resonance, Belgrade)
Introduction. Tuberculosis patients are rarely asymptomatic. Acute virus
myocarditis presents with a wide range of symptoms, from mild dyspnea or
chest pain to cardiogenic shock and death. Case Outline. A 26-year-old
Caucasian man non-smoker presented with one-week history of lower
extremities’ swelling. The patient’s medical history also revealed a two-day
episode of subfebrile temperature with scanty hemoptysis three weeks prior to
admission. The episode had not provoked him to seek medical care. Physical
examination revealed generalized oedema, and laboratory analysis showed signs
of acute renal insufficiency. Enlarged heart and hilar shadows, bilateral
massive cavitary pulmonary opacities and pleural effusion were found at chest
radiography. Sputum smears were Mycobacteria negative on direct microscopy.
Electrocardiogram changes and echocardiography were suggestive of acute
myocarditis with dilated cardiomyopathy. IgM titer to adenovirus was
positive. Under diuretics, angiotensin-converting-enzyme inhibitor,
beta-blocker, antibiotics and bed rest, fast heart compensation and renal
function repair were achieved. Radiographic pulmonary changes promptly
regressed except for a cavity in the right upper lobe. Bronchial aspirate
from the affected lobe was Mycobacteria positive on direct microscopy and
culture positive for Mycobacterium tuberculosis. Standard anti-tuberculosis
drug regimen led to recovery. Conclusion. In the unusual common existence of
two diseases whose presentation initially mimicked Wegener’s granulomatosis,
acute dilated cardiomyopathy contributed to pulmonary tuberculosis detection.
To prevent diagnostic delay in tuberculosis, further efforts in population
education are necessary together with continual medical education.
Keywords: tuberculosis, pulmonary, myocarditis, viral, cardiomyopathy, diagnostics, oedema, renal insufficiency
Projekat
Ministarstva nauke Republike Srbije, br. 175095