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Tuberculous pericarditis presenting as massive haemorrhagic pericardial effusion
Vivien Yan Chi Lee1, John Tai Hung Wong, Hon Cheung Fan
1Department of Family Medicine and Primary Health Care, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong. vivien.yc.lee@gmail.com
BMJ Case Reports
|June 30, 2012
Summary
Tuberculous pericarditis, a rare tuberculosis manifestation, was diagnosed in an elderly woman presenting with heart failure. Prompt diagnosis and treatment with anti-TB medications led to a full recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Tuberculosis (TB) can manifest as an extrapulmonary disease, affecting organs beyond the lungs.
- Tuberculous pericarditis is a rare but documented form of TB, particularly in regions with high TB prevalence.
- Elderly individuals with comorbidities like diabetes, hypertension, and hyperlipidemia may present with atypical symptoms.
Observation:
- An 82-year-old female patient with multiple comorbidities presented with symptoms of congestive heart failure.
- Echocardiography revealed a massive pericardial effusion (approximately 4 cm thick) without signs of cardiac tamponade.
- Diagnostic procedures included pericardiocentesis, tumor/auto-immune markers, and whole-body PET-CT scan.
Findings:
- Pericardial fluid analysis identified Mycobacterium tuberculosis through acid-fast bacilli culture and Genprobe examination.
- PET-CT scan showed increased fluorodeoxyglucose uptake in the pericardium, indicating inflammation but no malignancy.
- The patient received anti-tuberculosis treatment and tolerated it well.
Implications:
- This case highlights the importance of considering tuberculous pericarditis in the differential diagnosis of massive pericardial effusion, especially in at-risk populations.
- Early and accurate diagnosis through microbiological and imaging techniques is crucial for effective management.
- Successful treatment of tuberculous pericarditis can lead to complete resolution and prevent long-term cardiac complications.
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