Tuberculous pericarditis-a silent and challenging disease: A case report

Tuberculous pericarditis (TP) remains a challenge for endemic countries. In developing countries, one to two percent of patients with pulmonary tuberculosis develops TP.

A 49-year-old woman presented with dyspnea, chest pain and dry cough. On physical examination, veiled heart sounds were found. The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion. The patient was taken for an open pericardiotomy. The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli. Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive. The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain.

In cases of TP, obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis. Early diagnosis of this entity will allow physicians to initiate timely treatment, avoid complications and improve the patient's clinical outcome, so we consider the description of this case pertinent and its review in the literature.