Intramyocardial tuberculosis--a rare underdiagnosed entity.

A 38-year-old man, a fit kick-boxer, known anabolic steroid user and marijuana smoker, collapsed with shortness of breath in the casualty department and died. On autopsy, he was found to be muscular and heavily built, and had cardiomegaly, enlarged paratracheal lymph nodes and pulmonary oedema. His heart had a large fibrous nodular mass in the mitral valve cusp; there were numerous small, infiltrative, white, cheese-like lesions proximal to the aortic valve cusp and extending to the myocardium, and extensive fibrous thickening of the tricuspid valve cusp (Figs 1 and 2).