Isolated right atrium tuberculoma causing complete heart block

Myocardial tuberculosis was rare even in the era before effective anti-tuberculous chemotherapy was available. It is becoming even rarer with improved anti-tuberculous treatment. It was usually an incidental finding during necropsy. In a case series reported by Custer and Charr,1 they reviewed more than 14 000 deaths due to tuberculosis and found only 64 cases (0.5%) of tuberculosis involving the heart. In most cases the infection is either part of miliary tuberculosis or an extension of pericardial involvement. In the absence of these, it is presumed to be due to haematogenous or lymphatic dissemination.2 There is almost always a tuberculous focus elsewhere in the body; single isolated tuberculoma are very rare indeed. Complete heart block as a complication of myocardial tuberculosis has been described only rarely in medical literature. Thus far, only a limited number of cases have been reported,3–7 and none of these was due to a tuberculoma in the right atrium. A 35-year-old immunocompromised man was admitted with progressively worsening heart failure of 1-month duration. He had been diagnosed 3 months previously as having HIV and hepatitis C infection, but had defaulted on follow-up since then. History of note includes poor appetite, weight loss and intermittent low-grade fever for 1 week before admission. There was progressive worsening of pedal oedema and reduced effort tolerance during this period. He was an active intravenous drug user, but claimed that he had quit a year ago. He denied any syncope or loss of consciousness. He had previously been well and denied any history of contact with tuberculosis. …