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The exudative-constrictive tuberculosis pericarditis diagnosed by toracoscopic biopsy
O V Blagova1, I N Alijeva2, A V Nedostup1
1Department of Faculty Therapy No. 1, I.M.Sechenov First Moscow State Medical University (Sechenov University), Russian Federation.
Summary
Tuberculosis can cause resistant pericarditis with effusion and constriction, even with negative initial tests. Invasive diagnosis like thoracoscopic biopsy is crucial for accurate tuberculosis diagnosis and treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Exudative-constrictive pericarditis presents diagnostic and therapeutic challenges.
- A 31-year-old male patient experienced recurrent symptoms including fever, cough, syncope, and atrial fibrillation.
- Previous treatments with antibiotics and corticosteroids provided only temporary relief.
Purpose of the Study:
- To highlight the diagnostic and treatment complexities in a patient with resistant exudative-constrictive pericarditis.
- To emphasize the role of tuberculosis as a potential cause of pericarditis.
Main Methods:
- Computed tomography (CT) revealed pulmonary fibrosis and lymphadenopathy.
- Echocardiography (EchoCG) showed significant pericardial effusion with fibrin.
- Thoracoscopy with biopsy was performed for morphological examination and mycobacterial culture.
Main Results:
- Initial investigations for systemic diseases, hypothyroidism, and tumors were negative.
- Tuberculosis was confirmed by the presence of granulomas with caseous necrosis and positive Mycobacterium tuberculosis culture from sputum.
- Treatment included anti-tuberculosis drugs and corticosteroids, leading to regression of Ponce's disease. Subtotal pericardectomy was necessary due to constriction.
Conclusions:
- Tuberculosis is a significant cause of pericarditis leading to effusion and constriction.
- Negative laboratory tests for tuberculosis do not rule out the diagnosis.
- Invasive diagnostic methods, such as thoracoscopic biopsy, are essential for confirming tuberculosis in such cases.
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