'Tuberculosis pericarditis': a case report in a high-income country

The incidence of tuberculous (TB) infection varies greatly geographically. In endemic countries, it is one of the major aetiologies of pericardial diseases, whereas it is an uncommon cause in industrialized countries. The mortality rate of TB pericarditis complications is up to 40%, emphasizing the importance of early diagnosis and management.

An 82-year-old woman presented with fever, dry cough, and constitutional symptoms for 2 weeks. The electrocardiogram showed low-voltage complexes, chest X-ray showed unspecific changes, and blood work revealed mild anaemia and a slight elevation of inflammatory parameters. A diagnosis of pulmonary infection was assumed, and the patient was discharged with antibiotics. One month later, she presented with worsening exertion fatigue and an increase in cardiothoracic index was noted on the chest X-ray. Further imaging studies by computed tomography and echocardiography revealed a severe pericardial effusion (PE) with echocardiographic signs of hemodynamic instability. The patient underwent a pericardiocentesis. Polymerase chain reaction study for Mycobacterium tuberculosis in the pericardial fluid was positive. Pulmonary involvement was confirmed by videobronchoscopy with bronchoalveolar lavage. The patient received tetraconjugate management and corticosteroids with an adequate clinical response. The follow-up echocardiographic assessment showed mild PE with no constrictive physiology.

This is a case of definitive TB pericarditis that emphasizes the potential increase in TB cases in non-endemic countries and the need for a high clinical suspicion ensure early diagnosis and treatment, reducing complications and mortality of this disease.