CHEST Guidelines-A-38-Year-Old-Man-With-a-2-Month-History-of-Fever,

A-38-Year-Old-Man-With-a-2-Month-History-of-Fever,

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A 38-year-old Indian man in Greece, with a 2-month history of fever, night sweats, cough, palpitations, exertional dyspnea, anorexia, fatigue, and significant weight loss, was admitted for evaluation. The patient, with a history of poorly controlled diabetes and past alcohol dependence resulting in pancreatitis, underwent physical examination and diagnostic studies. Findings included fever, sinus tachycardia, and reduced breath sounds with signs indicative of pleural effusion. Lab results revealed hyperglycemia, mild hyponatremia, hypoalbuminemia, and elevated C-reactive protein. Chest X-ray showed pleural effusions, and a chest CT revealed pleural effusions with a cavitary lesion in the left upper lung. His ECG showed sinus tachycardia, with further cardiac evaluation indicating an enlarged left ventricle and severe systolic dysfunction. Serologic tests showed past Epstein-Barr and herpes simplex infections, and a tuberculin skin test was positive. <br /><br />The diagnosis was dilated cardiomyopathy due to tuberculous myocarditis within the context of disseminated tuberculosis (TB). Despite being a rare manifestation of TB, the disease can cause arrhythmias and heart failure. Advanced imaging and biopsy offer diagnostic clarity, but sensitivity challenges remain. CT and MRI facilitate noninvasive diagnosis, whereas endomyocardial biopsies, despite risks, may be pursued in specific cases. The patient was treated with antituberculous medications, resulting in clinical improvement and confirmation of TB in sputum cultures. Over 9 months, treatment showed benefits in heart function, though some fibrosis persisted, indicating good prognosis with sustained therapeutic intervention. Recommendations include combining imaging, cultures, and suspicion to confirm diagnosis, and using antitubercular treatment as primary management while addressing heart complications adjunctively.

Keywords

tuberculous myocarditis

dilated cardiomyopathy

disseminated tuberculosis

pleural effusion

antituberculous treatment

cardiac dysfunction

hyperglycemia

sinus tachycardia

cavitary lung lesion

endomyocardial biopsy