The Use of Corticosteroids in Patients With Pleural and Pericardial Tuberculosis

Tuberculous (TB) pleural effusions and pericarditis are relatively common extrapulmonary complications associated with this infection. Corticosteroids have been studied with standard antituberculous medications in the management of tuberculous pleural effusion and pericarditis due to their anti-inflammatory effect and their potential to modulate host inflammatory responses. However, current studies have reported conflicting results and inconsistent benefits of adjunctive corticosteroids with TB drug treatment. In TB pleural effusion, corticosteroids have reduced the duration of symptoms and accelerated the reabsorption of pleural fluid, but their long-term benefits, such as less residual pleural thickening and improved lung function, remain inconsistent across studies. Similarly, studies on TB pericarditis have shown mixed results, with some indicating faster resolution of symptoms and reduced incidence of constrictive pericarditis, while others found no difference in mortality and other complications. Although corticosteroids may offer some benefits in managing pleural or pericardial tuberculosis, the current evidence is not sufficient to support their routine use. Key questions include the optimal corticosteroid dosage, the timing of corticosteroid initiation during the infection, and the duration of corticosteroid treatment. More research is needed to determine which cases benefit from corticosteroids as adjunctive therapy in patients with pleural and pericardial tuberculosis.