title: Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas.
abstract: Tuberculosis is a leading cause of death worldwide. It affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. In this report, we describe two cases in which TB causes myopericarditis and presents with a broad-complex tachycardia that did not respond typically to standard anti-arrhythmic therapy; a very rare presentation with limited description in the literature. Both patients required extensive investigation culminating in identifying lymph nodes amenable to biopsy under endobronchial ultrasound guidance. It was not until both patients received anti-tuberculous chemotherapy alongside anti-arrhythmic management that any improvement to their condition was witnessed. Therefore, we recommend that the clinician should have a high index of suspicion for TB in any patient presenting with a broad-complex tachycardia that is not responding to standard first line management, especially if the patient is from a high risk background. We recommend an active diagnostic pursuit, and lymph node biopsy under endobronchial ultrasound guidance.
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Farah
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
authors.forename: V E
authors.initials: VE
authors.lastname: Beasley
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Berry
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
authors.forename: R K
authors.initials: RK
authors.lastname: Coker
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
authors.forename: O M
authors.initials: OM
authors.lastname: Kon
keywords: Arrhythmias; Cardiology arrhythmia-therapy; Endobronchial ultrasound; Tuberculosis