Myocardial tuberculosis: a diagnostic challenge illustrated by two cases and review of contemporary management

Myocardial tuberculosis is a rare form of extrapulmonary tuberculosis, characterized by variable clinical presentations and a potentially misleading diagnosis. We report two cases of myocardial tuberculosis: one case of disseminated disease involving the brain, lungs, lymph nodes, gastrointestinal tract, skin, and myocardium, and another case of isolated myocardial involvement. Both patients were treated with first-line anti-tuberculosis treatment. In addition, one patient received corticosteroids and therapeutic anticoagulation therapy. Clinical and radiological outcomes were favorable in both patients. Although extremely rare, myocardial tuberculosis should be considered, particularly in endemic settings. Cardiac magnetic resonance imaging is an essential diagnosis tool and should be integrated into a multimodal diagnostic approach combining clinical assessment, radiological features and bacteriologic or histological findings when available. Early initiation of antituberculosis therapy can lead to favorable clinical outcomes.