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Tuberculous Pericarditis in an Immunocompromised Patient: A Case Report
Nawaf Alotaibi1, Faisal Almutawa2, Alwaleed Alhazzaa3
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Cureus
|November 15, 2024
Summary
Tuberculous pericarditis (TBP) can present subtly in patients with pre-existing heart conditions. Early diagnosis via QuantiFERON-TB testing and imaging, followed by anti-tuberculosis therapy and surgery, is crucial for successful management.
Area of Science:
- Cardiology
- Infectious Diseases
- Rheumatology
Background:
- Tuberculous pericarditis (TBP) is a significant cause of pericardial disease, particularly in endemic regions.
- Co-morbidity with rheumatoid arthritis and chronic heart failure can complicate TBP presentation and management.
- This case highlights a complex clinical scenario involving a patient with multiple pre-existing conditions.
Observation:
- A 43-year-old male with a history of chronic severe pericarditis, right-sided heart failure, and rheumatoid arthritis presented with chest pain and dyspnea.
- Clinical examination revealed ascites and lower limb edema, indicative of advanced heart failure.
- Imaging demonstrated significant pericardial thickening and effusion, alongside necrotic lymph nodes.
Findings:
- Diagnostic workup confirmed tuberculous pericarditis (TBP).
- A positive QuantiFERON-TB test and characteristic imaging findings were key to diagnosis.
- The patient exhibited significant pericardial inflammation and lymphadenopathy.
Implications:
- This case underscores the importance of considering TBP in patients with unexplained pericardial effusions, even with co-existing conditions.
- Prompt diagnosis and a multi-modal treatment approach, including anti-tuberculosis therapy and potentially pericardiectomy, are vital for favorable outcomes.
- Timely intervention can improve prognosis and reduce long-term morbidity in TBP patients.
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