Pulmonary Tuberculosis Revealed by A Fusiform Coronary Aneurysm in A Patient with Acute Myocardial Infarction

Background: Coronary artery aneurysms (CAA) are rare (0.3 – 4.9 % of angiograms) and most often due to atherosclerosis. Granulomatous infections such as tuberculosis (TB) are an exceptional cause.

Case summary: A 53-year-old Mexican man presented with an extensive anterior ST-segment-elevation myocardial infarction. Coronary angiography revealed an 8-mm fusiform aneurysm in the proximal left-anterior-descending artery with preserved TIMI III flow and no obstructive lesions. Targeted history uncovered a two-year chronic cough and weight loss. Serial sputum smears were negative, but GeneXpert MTB/RIF was positive, confirming pulmonary TB. First-line antituberculous therapy was initiated; the patient remained hemodynamically stable without recurrent ischemia.

Discussion: In TB-endemic regions, Mycobacterium tuberculosis should be considered when a CAA lacks an atherosclerotic explanation. Advanced imaging plus microbiologic testing allows accurate diagnosis and may avert unnecessary coronary intervention, as antituberculous therapy alone can lead to aneurysm regression.

Learning points: Non-atherosclerotic CAAs mandate a broad etiologic work-up, including infections. Pulmonary TB may present solely with cardiovascular complications. GeneXpert MTB/RIF is a rapid, sensitive tool in acute settings. Multidisciplinary management (cardiology + infectious diseases) could optimize outcomes.