Tuberculous pericarditis due to silicon oxide exposure. A case report with an imaging approach

Abstract Introduction: This is a case report of a patient with tuberculous pericarditis, a rare form of tuberculosis associated with high morbidity and mortality. It contributes to the medical literature, given that it provides a comprehensive review of the imaging approach to this disease. Case presentation: A 52-year-old man previously exposed to silicon oxide who was referred to the Intensive Care Unit of a quaternary care hospital in the city of Bogotá (Colombia) due to hyperdense pericardial effusion, which was initially considered to have a neoplastic etiology. Imaging studies showed results suggestive of tuberculous pericarditis, prompting a pericardiocentesis, with microbiological and molecular detection studies in pericardial fluid that were negative for Mycobacterium tuberculosis and fungi. The only positive test was adenosine deaminase (ADA), thus raising the suspicion of tuberculous pericarditis. The definitive diagnosis was obtained via pericardial biopsy. Daily oral antituberculosis treatment was administered for 56 days, resulting in a significant improvement in the patient's condition. Conclusions: Tuberculous pericarditis should be suspected in patients presenting with hemorrhagic pericardial effusion, which can be reliably identified by ultrasound/echocardiography, CT, or MRI. It is recommended to include supportive diagnostic studies such as echocardiography, plain and contrasted CT of the chest, pericardiocentesis with ADA testing of pericardial fluid, and pericardial biopsy as the standard diagnostic approach in cases with clinical suspicion to reach a definitive diagnosis.