Dextrocardia with single atrium misdiagnosed as pulmonary tuberculosis in a 9 year old Nigerian girl: a case report

Abstract

Single atrium with dextrocardia is an uncommon congenital cardiac defect. The affected persons present with varying degrees of cyanosis and respiratory distress. These symptoms could easily be mistaken for pulmonary tuberculosis. We report the case of a 9 year old fully immunized female who presented to our hospital with a history of cough and difficulty in breathing of 5 months, body swelling of 1 month and weight loss of 2 weeks. There was no history of contact with an adult with chronic cough. There was a history of easy fatigability, cyanosis and recurrent respiratory tract infections noted from the age of 2 years. At the onset of symptoms, she was taken to a general hospital where a chest radiograph was done which showed cardiomegaly with prominent hilar opacities. Other ancillary tests for tuberculosis were not conducted. Based on a presumptive diagnosis of pulmonary tuberculosis, she was commenced on anti-tuberculosis drugs but with no relief of symptoms after 5 months of therapy. On examination, she was in respiratory distress, plethoric, cyanosed with grade 4 digital clubbing and bilateral leg oedema. She had a right sided apical impulse with a grade 5 systolic murmur and a loud second heart sound. Echocardiography done revealed dextrocardia, single atrium with severe regurgitation of the mitral valve and pulmonary hypertension. She was admitted and managed with intranasal oxygen, anti-failure regimen and oral pulmonary vasodilators and discontinued on the anti-tuberculous medications. Though the diagnosis of TB requires a high index of suspicion, confrmation is necessary to avoid misdiagnosis.

Keywords

• single atrium
• dextrocardia
• pulmonary tuberculosis
• misdiagnosis