Isolated interventricular septal tuberculoma causing complete heart block.

A 66-year-old man, seen in 1971 after a presyncopal episode, was found to have a heart rate of 32 beats per minute. His ECG showed complete heart block with narrow QRS complexes. After two Adams-Stokes attacks in hospital a temporary pacemaker was inserted. He had previously been well with no history of tuberculosis nor of contact with tuberculosis. Investigation showed no evidence of myocardial infarction and the Wassermann reaction was negative. A permanent pacing system (Devices 3821 generator with an endocardial electrode) was implanted and a postoperative chest radiograph showed a good electrode position with no abnormality. The patient remained well and had elective generator changes in 1974 and 1977. On both occasions the lateral chest film showed unexplained calcification within the heart shadow (fig 1). In 1980 he was admitted for a further elective generator change and was noted to be pale with purpura and splenomegaly. Recent investigation in his local hospital had established a diagnosis of non-Hodgkins' lymphoma with bone-marrow involvement and pancytopenia. A few days after his unit change he developed a fever for which no cause could be found. Despite appropriate treatment with antibiotics his condition deteriorated and he died. At necropsy the immediate cause of death was found to be a fungal bronchitis. The lymphoma was widespread and involved the bone marrow, intra-abdominal lymph nodes, liver, and spleen. The histological appearances were those of a non-histiocytic non-Hodgkin's lymphoma. There was extensive fibrosis and calcification in the