title: Triple valve endocarditis by mycobacterium tuberculosis: a case report.
abstract: BACKGROUND
  Granulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series.
  
  
  METHODS
  We report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement and tricuspid repair. The vegetations showed granulomatous inflammation but blood cultures and other biological specimen cultures were negative for any organisms. She was started on antituberculous treatment and anticoagulation.
  
  
  CONCLUSIONS
  This is the first reported case of triple valve endocarditis by Mycobacterium Tuberculosis in an immunocompetent host. Especially important is the fact that the right heart is involved which has been historically described in the setting of intravenous drug abuse.This implies that Tuberculosis should be considered in cases of culture negative endocarditis in endemic areas like Pakistan even in immunocompetent hosts.
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. quratulain.shaikh@aku.edu
authors.forename: Quratulain
authors.initials: Q
authors.lastname: Shaikh
authors.forename: Faisal
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage; D000995:Antitubercular Agents / Q000008:administration & dosage; D001021:Aortic Valve / Q000473:pathology; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008943:Mitral Valve / Q000473:pathology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010154:Pakistan; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014261:Tricuspid Valve / Q000473:pathology; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000925:Anticoagulants; D000995:Antitubercular Agents