Sudden Cardiac Arrest Caused by Tuberculous Pericarditis with Hemorrhagic Pericardial Effusion

Abstract

As tuberculosis still exists in Japan, tuberculous pericarditis is a major health issue. Tuberculous pericarditis is difficult to diagnose and leads to poor outcomes when left untreated. We herein report the case of a patient who was admitted to the hospital after undergoing resuscitation for cardiopulmonary arrest. Mycobacterium tuberculosis was detected in his hemorrhagic pericardial fluid and tuberculous pericarditis was diagnosed. The administration of antituberculous medication resulted in marked improvements. A diagnosis of tuberculous pericarditis, in addition to other causes such as malignant tumors, should therefore be considered in the differential diagnosis for cases presenting with hemorrhagic pericardial effusion, even in those involving sudden cardiac arrest.

Hemopericardio, taponamiento cardíaco, y absceso hepático en un varón joven

“…Tuberculosis and viruses are the main causes of pericarditis; a condition categorized as fibrinous, fibrinous purulent, unspecific chronic, hemorrhagic, granulomatous, caseous, constrictive, post-myocardial infarction, and Dressler's syndrome. 2,4,16,19 Hemopericardium is usually associated with tuberculosis, malignant infiltration, and previous cardiac surgery; 2,16,19 in the present case study the hemorrhagic fluid had a relationship with S. aureus infection. 3 Worthy of note, this agent has been very often associated with blood borne dissemination, evolving to sepsis or shock with acute tubular necrosis, and also myocardial abscess.…”

“…1,2,4,9,[14][15][16] Additionally to infections, malignancy, myocardial infarction, autoimmune diseases, uremia, hypothyroidism, radiation, drugs, and iatrogenesis can cause www.medigraphic.org.mx www.medigraphic.org.mx dissection, malignancy, trauma, uremia, tuberculosis and drugs. 2,[16][17][18][19] Worthy of note is the overlapping of hemorrhagic with other type of pericardial effusion, as described in cardiac tamponade due to purulent pericarditis by Staphylococcal infection. 6,17 The modality of drainage procedure is not yet consensual and depends upon the type of effusion, general patient health, physician experience, and institutional resources.…”

Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis

“…In this context, the heart is the most important organ 23 , 26. Most patients with cardiac TB are asymptomatic before death, and antemortem diagnosis is extremely rare 26 - 31. Cardiac TB is usually secondary to lesions elsewhere in the body.…”

“…The mechanism of SD in TB myocarditis has been hypothesized to be ventricular tachyarrhythmias,23 , 26 , 32 - 34 , 37 , 38 although direct records of ventricular arrhythmia are lacking 23 , 26 , 30 , 39. When the pericardium is affected by TB, pericarditis and/or cardiac tamponade may develop, and they could be a cause of SD 31. TB involving the endocardium is extremely rare,35 , 40 and SD resulting from endocardial TB has not been reported so far.…”

Tuberculosis pericárdica con efusión hemorrágica

“…A la tuberculosis le corresponde el 2 % de las efusiones pericárdicas hemorrágicas, pero en países como Perú se le debe tener presente en el diagnóstico diferencial. 10 La actividad incrementada de la ADA en el líquido pericárdico tiene una sensibilidad de 89% y una especificidad de 72% para el diagnóstico de PTB. La ADA es una enzima que cataliza la desaminación de la adenosina hacia sus respectivos nucleótidos de inosina.…”