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Tuberculous pericarditis in an infant evolving during triple chemotherapy
Jochen Meyburg1, Klaus G Schmidt, Walter Nützenadel
1Department of Paediatrics, University of Heidelberg, Germany. jochen_meyburg@med.uni-hedelberg.de
Insights
Tuberculosis in infants requires close monitoring for drug side effects and early detection of extrapulmonary spread. Prompt intervention for tuberculous pericarditis can prevent constriction and ensure full recovery.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Tuberculosis (TB) is a significant global health concern, particularly in pediatric populations.
- Pulmonary TB is commonly treated with a combination of antitubercular drugs.
Observation:
- A 36-month-old girl with pulmonary TB developed acute pericardial tamponade four weeks after initiating standard chemotherapy.
- Tuberculous pericarditis was diagnosed via echocardiography and confirmed by detecting Mycobacterium tuberculosis in pericardial fluid through microscopy, PCR, and culture.
- The patient underwent pericardiocentesis for pericardial effusion drainage.
Findings:
- The patient received extended antitubercular therapy including streptomycin and prednisone.
- Complete recovery was achieved without evidence of constrictive pericarditis following pericardial drainage and adjusted treatment.
Implications:
- This case highlights the importance of vigilant monitoring in infants treated for TB, not only for drug toxicity but also for early identification of extrapulmonary dissemination.
- Timely diagnosis and intervention in tuberculous pericarditis are crucial for preventing long-term complications like constrictive pericarditis and achieving favorable outcomes.
Unlabelled:
A 36-month-old girl was treated for pulmonary tuberculosis (Mycobacterium tuberculosis) with isoniazid, rifampin and pyrazinamide. Four weeks after starting chemotherapy, she developed high fever and clinical signs of acute pericardial tamponade. Pericardial effusion was shown by echocardiography and subsequently removed by pericardiocentesis. M. tuberculosis was demonstrated in the pericardial fluid by microscopy, polymerase chain reaction and specific culture. After pericardial drainage, the actual therapy was extended to include streptomycin and prednisone. Follow-up examinations demonstrated complete recovery without signs of constrictive pericarditis.
Conclusion:
infants treated for tuberculosis should be followed closely in order to monitor not only side-effects of antituberculous drugs but also to detect early extrapulmonary spread that may occur even with adequate chemotherapy. Rapid intervention and treatment adjustment in infants with tuberculous pericarditis may prevent pericardial constriction and may lead to full recovery.