Different Histopathological Appearances of Cardiac Tuberculosis: Presentation of a Rare Case with Review of Literature

Tuberculosis is caused by a mycobacterium and is a multipotential, omnipresent infectious disease. Generally, two major categories, pulmonary and extrapulmonary exist. Whereas pericardial involvement is relatively common, myocardial tuberculosis has been reported in not more than 0.3% of all tuberculosis patients post-mortem. A 21-year-old woman sought medical attention due to progressive dyspnea upon exertion, weight loss, and general weakness. She underwent a heart operation and a well-circumscribed, solid , and creamy egg-shaped mass with a lobulated surface was seen in the right atrium. The histopathological study showed multiple well-formed granulomas with multinucleated giant cells and extensive caseous necrosis. These were compatible with a diagnosis of tuberculoma; however, the Ziehl-Neelsen stain failed to reveal the acid-fast bacilli. Her postoperative course was uneventful and soon she was discharged with advice to continue her medical therapy