Key result
Oral antitubercular therapy without steroids reverses tubercular constrictive pericarditis after 4 months in a case report.
Why the study?
Complete reversal of constrictive pericarditis physiology using antitubercular therapy without adjuvant anti-inflammatory drugs had not been documented.
Does oral antitubercular therapy without steroids reverse constriction physiology in a patient with tubercular constrictive pericarditis?
Case Report (n=1)
Does oral antitubercular therapy without steroids reverse constriction physiology in a patient with tubercular constrictive pericarditis?
Antitubercular therapy alone, without adjuvant steroids, can completely reverse constriction physiology in early-stage tubercular constrictive pericarditis.
Hypothesis-generating for ATT monotherapy in early tubercular constriction; prospective trials needed before clinical adoption.
BACKGROUND: Constrictive pericarditis is a chronic inflammation of the pericardium leading to the thickening of the pericardium that restricts cardiac filling. Globally tuberculosis is the commonest aetiology of constrictive pericarditis. Though normally considered to be an irreversible pathology; which requires surgical pericardiectomy, in early stage of the disease antitubercular therapy (ATT) along with steroids and other anti-inflammatory therapy can reverse the pathology. But, complete reversal of constrictive physiology with ATT without any anti-inflammatory drugs is not documented. CASE SUMMARY: Here, we describe a case where a 54-year-old lady presented with progressive dyspnoea and pedal oedema for 2 years along with anorexia and weight loss for two months. Two-dimensional echocardiography and computed tomography scan was suggestive of constrictive pericarditis. In view of systemic features and high acute phase reactants, patient was started on oral ATT without any steroids. After 4 months, constriction physiology was completely reversed. DISCUSSION: Constriction physiology if treated timely can be largely reversed only with ATT without adjuvant anti-inflammatory therapy. Further studies are required to find out the specific indications of anti-inflammatory therapy in tubercular constrictive pericarditis.
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Bagchi et al. (2019) conducted a case report in Tubercular constrictive pericarditis (n=1). Oral antitubercular therapy (ATT) without steroids was evaluated on Reversal of constriction physiology. Oral antitubercular therapy without adjuvant steroids completely reversed constriction physiology in a 54-year-old woman with tubercular constrictive pericarditis after 4 months.
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