A shorter-than-recommended 6-month course of antitubercular therapy effectively managed pericardial tuberculosis and cardiac tamponade in a 19-year-old male with common variable immunodeficiency.
Case Report (n=1)
No
A shorter 6-month course of antitubercular therapy was effective in treating tuberculous pericardial effusion with cardiac tamponade, even in a patient with underlying common variable immunodeficiency.
INTRODUCTION: Extrapulmonary tuberculosis (EPTB) adds to India's significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. PRESENTATION: This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. CONCLUSION: This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
Ravikumar et al. (Mon,) conducted a case report in Extrapulmonary tuberculosis (pericardial effusion and cardiac tamponade) and Common variable immunodeficiency disease (n=1). Antitubercular therapy (isoniazid, rifampin, pyrazinamide, ethambutol) was evaluated on Symptom resolution and cardiac function improvement. A shorter-than-recommended 6-month course of antitubercular therapy effectively managed pericardial tuberculosis and cardiac tamponade in a 19-year-old male with common variable immunodeficiency.
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