Tuberculous Miliary Presenting with Fulminant Myocarditis

Tuberculosis miliaria is a disseminated form of infection by Mycobacterium tuberculosis, most often via the hematogenous or lymphatic route. Depending on its degree of extension, it can lead to severe organ failure, which may explain its high mortality rate. Cardiac involvement during tuberculosis miliaria worsens the prognosis of these patients. This localization remains rare, and most often results in pericarditis with pericardial effusion, while fulminant myocarditis is extremely rare. Anti-bacillary treatment is a therapeutic emergency. Cardiocirculatory resuscitation of the associated hemodynamic instability is similar to that of any state of cardiogenic shock, and calls for vasoactive and positive inotropic amines after adequate filling. The role of corticosteroid therapy is still under discussion. Prognosis depends on the degree of organ failure, the presence of severe malnutrition, tolerance of antibacillary treatment and the existence of resistant or non-resistant strains of Mycobacterium tuberculosis.