Tuberculous coronary arteritis as a rare cause of sudden cardiac death in young adults: a case report and a literature-based review.

BACKGROUND

Sudden Cardiac Death (SCD) is generally attributed to coronary atherosclerosis. Tuberculous Coronary Arteritis (TCA), an exceptionally rare manifestation of tuberculosis (TB), is a severe, often unrecognized, infectious cause of SCD. This report highlights TCA as a fatal etiology of SCD and reviews its key clinical and pathological features to enhance diagnostic awareness.

METHODS

A regular narrative literature review was performed using the MEDLINE, Scopus, Embase, and Web of Science databases, with the following search terms: ("Tuberculous Coronary Arteritis" OR "Coronary Tuberculosis") AND ("Sudden Cardiac Death" OR "Myocardial Infarction"). We included histologically confirmed TCA cases in which arteritis was the direct cause of a fatal acute ischemic event or SCD, with a focus on young patients.

CASE REPORT: A 28-year-old previously healthy man collapsed at work and died despite resuscitation. Autopsy revealed diffusely thickened coronary arteries (CA) with periarterial fibrosis and grayish perihilar pulmonary consolidation. No other significant gross abnormalities were identified. Histological examination showed granulomatous inflammation in CA, lungs, and mediastinal lymph nodes with caseating necrosis involving only the lungs and mediastinal lymph nodes. PCR confirmed Mycobacterium tuberculosis despite negative Ziehl-Neelsen staining. Death was attributed to TCA complicated by thrombosis, stenosis, and myocardial infarction.

CONCLUSION

TCA is a rare, life-threatening extrapulmonary manifestation of TB that may cause SCD in young individuals without cardiovascular risk factors. Its nonspecific presentation means it is rarely suspected during life and is usually diagnosed postmortem. Increased clinical and forensic awareness, especially in TB-endemic areas, is essential for accurate cause-of-death determination and appropriate public health action.