Abstract
Tuberculosis is responsible for 70% cases of large pericardial effusion and 2% of cardiac tamponade. A-21-year-old female sought medical care due to progressive dyspnea and chest discomfort. Tuberculous pericarditis with pericardial effusion was diagnosed based on muffled heart sound along with regular tachycardia and jugular vein distention on cardiovascular examination, high CRP with positive IGRA, ECG showed low voltage criteria, right pericardial effusion on chest x-ray, and echocardiography showed massive pericardial effusion with fibrous (echogenic) profile surrounding the heart which was swinging inside with signs of early tamponade. The patient underwent an urgent pericardiocentesis and analysis of pericardial fluid was suggestive of TB. Patient was given oral anti-tuberculosis therapy, corticosteroid and colchicine and showed remarkable improvement. Pericardial effusion contribute to higher morbidity and mortality of the patients with TB. Early identification and diagnosis confirmation are essential to start the appropriate medication and intervention to improve the outcomes of the patients.
Keywords: Tuberculosis, Pericarditis, Pericardial Effusion.
References
- Wanjari K, Baradkar V, Mathur M, Kumar S. A Case of Tuberculous Pericardial Effusion. Indian J Med Microbiol. 2009;27(1):75–7.
- Mayosi BM, Burgess LJ, Doubell AF. TuberculousPericarditis.Circulation. 2005 Dec 6;112(23):3608–16.
- Syed FF, Mayosi BM. A Modern Approach to Tuberculous Pericarditis. Prog Cardiovasc Dis. 2007 Nov;50(3): 218–36.
- Rai DK, Kumar A. A rare case of cardiac tamponade due to tuberculosis.Int J Adv Med. 2017 Jan 23;4(1):296.
- Liu C, Cui Y-L, Ding C-M, Wu Y-H, Li H-L, Liu X-F, et al. Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis. J Thorac Dis. 2018 Feb;10(2):854–60.
- Cherian G. Diagnosis of tuberculous-aetiology in pericardial effusions. Postgrad Med J. 2004 May 1;80(943):262–6.
- Shaheen, Rajyashri S, Anjum P, Jayshree P. An Unusual Presentation of Tuberculous Pericardial Effusion. South Asian Fed Obstet Gynecol. 2009;1(3):71–2.
- Trautner BW, Darouiche RO. Tuberculous Pericarditis: Optimal Diagnosis and Management. Clin Infect Dis. 2001;33:954–61.
- Farnetano B dos S, Farias ML, Mota GSM, Leao CN, Machareth MMV. Pericardial Tuberculosis-A Case Report. J Tuberc Ther. 2007;1(1).
- Singh S, Tiwari K. Use of corticosteroids in tuberculosis. J Assoc Chest Physicians. 2017;5(2):70.
- Evans DJ. The use of adjunctive corticosteroids in the treatment of pericardial, pleural and meningeal tuberculosis: Do they improve outcome? Respir Med. 2008 Jun;102(6):793–800.
- Shah SR, Alweis R, Shah SA, Arshad MH, Manji AA-K, Arfeen AA, et al. Effects of colchicine on pericardial diseases: a review of the literature and current evidence. J Community Hosp Intern Med Perspect. 2016 Jan;6(3):31957.
- Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921–64.
Corresponding Author
Dian Daniella
Siloam Hospitals Kebon Jeruk
Jl. Pejuangan Raya number 8, Kebon Jeruk, West Jakarta