Favourable outcome in a child with presumed tubercular pancarditis treated with empirical antitubercular therapy

Cardiac tuberculosis (TB) as an extrapulmonary manifestation of TB is rare. Pericarditis is a common manifestation while myocarditis and endocarditis are less common. Tubercular pancarditis is extremely rare. Endomyocardial involvement of TB is generally clinically silent and present as sudden death due to arrhythmias. It is recommended that empirical antitubercular therapy (ATT) on the basis of clinical suspicion should be avoided in countries where TB is highly prevalent. However, delaying ATT in endomyocardial TB and extensive investigations for demonstration or culture of acid-fast bacilli (AFB) may be associated with morbidity and may lead to catastrophic consequences, especially in a sick child. We present a child with TB pancarditis who presented with congestive cardiac failure and empirical ATT was started after extensive efforts to demonstrate AFB failed and the outcome was good.