A life-threatening pericardial tamponade revealing disseminated tuberculosis: A challenging medical care

Tuberculous pericarditis (TBP) is one of the most important causes of pericarditis in developing countries in which tuberculosis remains a public health problem. We report the case of a 20-year-old immunocompetent woman who presented with hypotension and tachycardia echocardiography showed a massive pericardial effusion and signs of tamponade. The patient underwent an urgent pericardiocentesis; 700 ccs of serosanguinous pericardial fluid was drained. She had a surgical biopsy of the pleuropericardial window. The pathological examination confirmed TBP. Oral anti-tuberculosis therapy was initiated. Two months after therapy started, she was admitted for dyspnea and edema of the lower limbs. Echocardiography showed paradoxical inter-ventricular septum and non-compliant dilated inferior vena cava. She has been set on diuretics associated with Akurit for another two months. Thoracic CT scan done at 4 months of tuberculosis treatment showed: thickening of the pericardial layers, with an encysted collection facing the trunk of the pulmonary artery, bilateral pleural effusion, and thickening of the peribronchovascular and interlobular septa of the right lung, due to lymphatic stasis. We then switched to dual therapy for a total of eight months. An ultrasound check at the end of treatment was performed showing the absence of pericardial effusion with diminished systolic ejection fraction (54%). This case is the witness that TBP can be life-threatening even for immunocompetent patients. The risk is the evolution towards sequelae and constrictive pericarditis. The high mortality and morbidity from TBP despite the use of anti-tuberculous drugs call for research targeting host-directed immunological determinants of treatment outcome.