Tuberculous endocarditis: a case-based proposal for new diagnostic criteria.

Background: Tuberculous endocarditis (TBE) is a rare but often fatal manifestation of Mycobacterium tuberculosis. Although diagnosis is now possible with advanced techniques, the lack of standardized diagnostic criteria complicates timely recognition and management.

Methods: A 79-year-old man with a history of the Bentall procedure for annuloaortic ectasia, presented with fever and chest pain. Imaging revealed infective endocarditis with an aortic root abscess and vegetations. Histopathology identified granulation tissue with multinucleated giant cells, and M. tuberculosis was confirmed via PCR and culture. A literature review of TBE cases was performed to develop systematic diagnostic criteria.

Results: The diagnosis of TBE was established through histopathology and molecular methods. Based on this case and prior reports, diagnostic criteria for TBE were developed and categorized as 'Definitive', 'Probable', and 'Possible'. These criteria incorporate clinical, microbiological, histological, and imaging findings to aid in diagnosis. The patient's treatment included surgical intervention combined with antimicrobial therapy, aligning with strategies designed to improve outcomes.

Conclusion: This case underscores the importance of considering TBE in infective endocarditis cases, especially those with atypical features. The proposed diagnostic criteria aim to improve the recognition and guide the management of TBE, emphasizing a multidisciplinary approach for better patient outcomes.