Tuberculosis pericarditis: a case report

Authors

  • Martine A. Louis Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Arpana S. Singh St. George’s University School of Medicine, Grenada, West Indies
  • Shubham Bhatia Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Sheppard C. Webb Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Patrick K. Kiarie St. George’s University School of Medicine, Grenada, West Indies
  • Luke Keating Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Kellyann K. Inniss Ross University School of Medicine, St. Michael, Barbados

DOI:

https://doi.org/10.18203/2349-2902.isj20243251

Keywords:

Tuberculosis, Pericarditis, Pericardial window, Pericardiocentesis, Pleurisy, Cardiac tamponade

Abstract

Tuberculosis (TB) is still prevalent in the world. In 2020, 1.5 million people died from TB.18 TB accounts for 4% of acute pericarditis. Tuberculous pericarditis (TBP) is due to hypersensitivity to tuberculin protein produced by Mycobacterium tuberculosis and develops in 1-2% of pulmonary TB cases, representing about 1-2% of extrapulmonary tuberculosis. Complications occur in the form of acute pericarditis (4%) and cardiac tamponade (7%), which may require life-saving invasive procedures. Tuberculous pericarditis has an overall mortality rate of 1.43 per 100 person-months over a median follow-up of 11.97 months. Risk factors include diabetes, substance use disorder, HIV-positivity, renal insufficiency, biological or immunosuppressive therapy, and exposure to regions with a high prevalence of tuberculosis. We present a 49-year-old diabetic male with a large complex pericardial effusion occurring three months after a diagnosis of TB pleurisy on antituberculosis drugs, which required pericardiocentesis and pericardial window in the context of cardiac tamponade. Cases of TB pericarditis in developed countries are rarely reported, and there are even fewer in the US. Along with a literature review of the road map for its accurate diagnosis and treatment, this case highlights the relevance of TB in the differential of pericarditis worldwide, even in developed countries.

References

Jung IY, Song YG, Choi JY, Kim MH, Jeon WY, Oh DH, et al. Predictive factors for unfavourable outcomes of tuberculous pericarditis in human immunodeficiency virus–uninfected patients in an intermediate tuberculosis burden country. BMC Infectious Dis. 2016;16(1):2062-5

Denk A, Kobat MA, Balin SO, Kara SS, Dogdu O. Tuberculous pericarditis: a case report. Le Infezioni in Medicina. 2016;24(4):337–9.

Sidhu KK, Seyfi D, Lau NS, Yeo D. The rare case of oesophago-pericardial fistula secondary to pulmonary tuberculosis. J Surg Case Reports. 2022(9):422.

Dybowska M, Błasińska K, Gątarek J, Klatt M, Augustynowicz-Kopeć E, Tomkowski W, et al. Tuberculous pericarditis-own experiences and recent recommendations. Diagnostics. 2022;12(3):619.

Dybowska M, Szturmowicz M, Błasińska K, Gątarek J, Augustynowicz-Kopeć E, Langfort R, et al. Large pericardial effusion—diagnostic and therapeutic options, with a special attention to the role of prolonged pericardial fluid drainage. Diagnostics. 2022;12(6):1453.

Kopcinovic LM, Culej J. Pleural, peritoneal and pericardial effusions-a biochemical approach. Biochemia Medica. 2014;3:123-37.

Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol. 2006;118(3):286-94.

Giordani AS, De Gaspari M, Baritussio A, Rizzo S, Carturan E, Basso C, et al. A rare cause of effusive–constrictive pericarditis. ESC Heart Failure. 2021;8(5):4313-7.

Nanyoshi M, Amano S, Fujimori T, Sano C, Ohta R. Tuberculous pleurisy diagnosed from massive pleural effusion in an older patient with no history of tuberculosis. Cureus. 2022.

Jeon D. Tuberculous pleurisy: an update. tuberculosis and respiratory diseases. BMJ. 2014;76(4):153.

Isiguzo G, Du Bruyn E, Howlett P, Ntsekhe M. Diagnosis and management of tuberculous pericarditis. Current Cardio Rep. 2007;22(1)1254.

Reuter H, Burgess LJ, Louw VJ, Doubell AF. The management of tuberculous pericardial effusion: experience in 233 consecutive patients. Cardiovasc J S Afr. 2007;18(1):20-5.

Trautner BW, Darouiche RO. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis. 2001;33(7):954-61.

Mayosi BM, Burgess L, Doubell A. Tuberculous Pericarditis. Circulation, 2005;112(23):3608–16.

Haqs IU, Davies DR, Yao R, Bratt A, Sinak LJ, Singh M. Effusive-constrictive tuberculosis pericarditis with biventricular systolic dysfunction. CASE. 2022;6(5):212–7.

Srivastava S, Sharad N, Ningombam A, Kumar D, Malhotra R, Mathur P. tuberculous pericarditis in a patient with COVID-19. 2023. J Applied Lab Med. 2023;8(3):645-8.

Vorster MJ, Allwood BW, Diacon AH, Koegelenberg CF. Tuberculous pleural effusions: advances and controversies. J Thorac Dis. 2015;7(6):981-91.

Seung KJ, Keshavjee S, Rich ML. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Cold Spring Harb Perspect Med. 2015;5(9):17863.

Downloads

Published

2024-10-28

Issue

Section

Case Reports