Details

Autor(en) / Beteiligte

• Aziminia, Nikoo
• Soman, Biji
• Samoes, Jose
• Randhawa, Rabinder
• Ormerod, Julian O M
• Kardos, Attila

Titel

A diagnostic conundrum of a “ring of fire”: a case of tuberculous perimyocarditis

Ist Teil von

• The Lancet (British edition), 2023-02, Vol.401 (10375), p.470-471

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2023

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Laboratory investigations showed a raised high-sensitive cardiac troponin-I (hs-TNI) concentration (60·6 ng/L; normal range 2·0–19·9), brain natriuretic peptide concentration (380; normal range 0–100), and C-reactive protein concentration (55 mg/l; normal 0–0·5). Viral serology ruled out recent viral infection; HIV serology, serum angiotensin-converting-enzyme, autoimmune screen, and TB ELISpot were negative. A heterogeneous mass, involving the visceral pericardium and invading the left ventricular myocardium, with evidence of oedema and inflammation on T2-weighed MRI, and patchy fibrosis on late gadolinium enhancement in the thickened segments (figure), were also seen. 18F-fluorodeoxyglucose PET/CT showed increased activity in the pericardium—the so-called ring-of-fire sign—and the left ventricular wall; in the subcarinal, paratracheal, thoracic inlet, gastrohepatic, ileocolic, and right inguinal lymph nodes; and in lytic bone lesions in the seventh and ninth left ribs and fifth lumbar vertebra (figure).