Tubercular Myocarditis with Intracardiac Thrombus in a Child: A Rare Pediatric Presentation of Tuberculosis

Abstract

Background: Tubercular myocarditis is an exceedingly rare manifestation of Mycobacterium tuberculosis, with pediatric cases being exceptionally uncommon. Children typically present with pulmonary or lymph node tuberculosis (TB), while myocardial involvement is reported only in isolated cases. This report highlights a rifampicin-resistant pediatric TB case complicated by myocarditis and left ventricular thrombus. Case Presentation: A 11-year-old girl presented with chronic fever, cough, dyspnea, and generalized edema. Examination showed anasarca, tachycardia with gallop rhythm, systolic murmur, and bilateral crackles. Chest radiograph revealed infiltrates. Echocardiography showed left ventricular dysfunction (Ejection fraction - 30%) and an apical thrombus. Sputum was positive for acid-fast bacilli and CB-NAAT detected rifampicin-resistant TB. She received MDR-TB therapy, anticoagulation, and heart failure treatment. Serial echocardiograms showed thrombus regression and full recovery in four months. Conclusion: Pediatric tubercular myocarditis is extremely rare. Myocardial involvement should be suspected in TB children presenting with heart failure. CB-NAAT is essential for rapid diagnosis. Anticoagulation helps thrombus resolution and improves outcomes.