Tuberculous pericarditis: three cases and brief review

Abstract

Tuberculous pericarditis is a form of extrapulmonary tuberculosis that is considered unusual in western coun-tries. Diagnosis is often challenging, while proper treatment has a major impact on prognosis. We present three interesting cases, with complicated or unusual manifestations of tuberculous pericarditis: a patient with cardiac tamponade as the initial manifestation of tuberculosis; a patient progressing to constriction despite adequate treatment; and a patient receiving anti-TNFalpha, who developed pericarditis in the context of immune reconstitution inflammatory syndrome. We briefly review the clinical features of tuberculous pericarditis, whilst our main focus is on the available diagnostic techniques and treatment aspects. In conclusion, tuberculous pericarditis remains an active thread in the western world. A high index of suspicion combined with the use of all available diagnostic techniques are important to increase diagnostic yield. Prompt and effective treatment is essential to reduce morbidity and mortality.

Clinical Case: Tuberculous Myopericarditis in the Cardiology Practice

“…Обращает на себя внимание тот факт, что туберкулиновая кожная проба была отрицательна. Пациент имел хороший ответ на терапию и был выписан через 20 дней после операции [12].…”

Insights into Imaging of Pericardial and Cardiac Tuberculosis: A Comprehensive Review

“…11 It is possible for CP to last for several years, before symptomatic heart failure develops. 12 Tuberculous pericarditis has four recognized pathological stages and different clinical presentation:…”

Constrictive Pericarditis and Tuberculosis: Is It Worth More Attention？

“…There is no consensus on the scope of a pericardiectomy for the surgical treatment of chronic constrictive pericarditis. A total pericardiectomy is technically more demanding but has superior resultsboth early and late compared with partial pericardiectomy [56] . The process of pericardiectomy is difficult, especially with calcification penetrating the myocardium, which may damage myocardial laceration and endanger life during operation [57] .…”

“…At the same time, diuretic therapy, inotropic support and some device support such as cardiopulmonary bypass (CPB), ultrasonic bone scalpel, and extracorporeal membrane oxygenation (ECMO) may be needed during or after the pericardiectomy. Besides, advanced age, atrial fibrillation, tricuspid insufficiency, need for inotropic support, low cardiac output, high atrial pressure, ascites, low functional status and the duration of constriction have been related to poor outcomes [56] .…”