Lucero OD, Bustos MM, Ariza Rodríguez DJ, Perez JC. Tuberculous pericarditis-a silent and challenging disease: A case report. World J Clin Cases 2022; 10(6): 1869-1875 [PMID: 35317150 DOI: 10.12998/wjcc.v10.i6.1869]
Corresponding Author of This Article
Oscar David Lucero, MD, Doctor, Department of Internal Medicine, Hospital Universitario San Ignacio, Cra. 7 No. 40-62, Bogotá 110231, Colombia. oscardavidlucero21@gmail.com
Research Domain of This Article
Anatomy & Morphology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2022; 10(6): 1869-1875 Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1869
Tuberculous pericarditis-a silent and challenging disease: A case report
Oscar David Lucero, Marlon Mauricio Bustos, Darwin Jhoan Ariza Rodríguez, Juan Camilo Perez
Oscar David Lucero, Marlon Mauricio Bustos, Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
Darwin Jhoan Ariza Rodríguez, Juan Camilo Perez, Internal Medicine Resident, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
Author contributions: Bustos MM participated in the conception of the work and review of the final version; Lucero OD contributed to the conception of the work and the preparation of the manuscript; Ariza Rodríguez DJ participated in the preparation of the manuscript and the bibliographic review; Perez JC participated in the design of the work and analysis; all authors have read and approved the final manuscript.
Informed consent statement: Written consent was provided by the patient.
Conflict-of-interest statement: The authors have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oscar David Lucero, MD, Doctor, Department of Internal Medicine, Hospital Universitario San Ignacio, Cra. 7 No. 40-62, Bogotá 110231, Colombia. oscardavidlucero21@gmail.com
Received: June 21, 2021 Peer-review started: June 21, 2021 First decision: July 26, 2021 Revised: September 7, 2021 Accepted: January 19, 2022 Article in press: January 19, 2022 Published online: February 26, 2022
Abstract
BACKGROUND
Tuberculous pericarditis (TP) remains a challenge for endemic countries. In developing countries, one to two percent of patients with pulmonary tuberculosis develops TP.
CASE SUMMARY
A 49-year-old woman presented with dyspnea, chest pain and dry cough. On physical examination, veiled heart sounds were found. The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion. The patient was taken for an open pericardiotomy. The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli. Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive. The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain.
CONCLUSION
In cases of TP, obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis. Early diagnosis of this entity will allow physicians to initiate timely treatment, avoid complications and improve the patient's clinical outcome, so we consider the description of this case pertinent and its review in the literature.
Core Tip: Tuberculous pericarditis should be suspected in the evaluation of all cases of pericarditis that do not have a self-limited course. The present case identifies the usefulness of the study of Adenosine deaminase in the pericardial fluid and the performance of polymerase chain reaction for Mycobacterium tuberculosis in the biopsy, thanks to which the diagnosis could be confirmed. Management is based on the use of rifampin, isoniazid, ethambutol, and pyrazinamide.
