Emergent pericardiocentesis and a 12-month rifampin-based four-drug regimen led to marked symptomatic improvement and no recurrence of pericardial effusion at 1 year in an 82-year-old man with tuberculous cardiac tamponade.
Case Report (n=1)
No
Tuberculous pericarditis should be considered in the differential diagnosis of large pericardial effusions with tamponade in patients from TB-endemic regions, even with remote migration history.
Abstract Introduction Tuberculous infection presenting with pericarditis is uncommon in low-burden settings yet remains a critical etiology of large pericardial effusions in patients from TB-endemic regions. Delayed recognition may lead to life-threatening tamponade. Case Presentation An 82-year-old man with hypertension, hyperlipidemia, benign prostatic hyperplasia, and remote tobacco use, HIV negative, originally from Mexico but migrated to the United States in the 1980s with no recent travel history, presented to the hospital with complaints of one week of fatigue, malaise, productive cough, and dyspnea. Initial chest radiograph showed the presence of cardiomegaly with pulmonary vascular congestion. Transthoracic echocardiography revealed a large pericardial effusion with pericardial tamponade. Figure 1. Emergent pericardiocentesis was performed, an opening intrapericardial pressure of 10 mm Hg was noted, and approximately 1 L of hemorrhagic fluid was drained. Further imaging with CT of the chest demonstrated the presence of multiple bilateral pulmonary nodules, calcified mediastinal lymphadenopathy, and a small loculated left pleural effusion. Mycobacterium tuberculosis complex grew from both sputum samples and pericardial fluid cultures. The patient was treated with a rifampin-based four-drug regimen for approximately twelve months with marked symptomatic improvement and no recurrence of pericardial effusion after a year of follow-up. Discussion Tuberculous pericarditis accounts for around ∼1-2% of all TB cases; this has been described especially among immigrants from intermediate- or high-burden regions. Mortality has been described in 17-60% of the cases. Frequently, clinical presentations may be non-specific, and in older adults, due to multiple comorbidities, cardiomegaly and dyspnea are often initially attributed to heart failure or malignancy. Confirming the presence of bacteria in pericardial fluid, although uncommon (with some references reporting 38-56% of cases), provides a definitive diagnosis and guides management. Conclusion TB should remain in the differential diagnosis of large pericardial effusions with tamponade physiology in patients from TB-prevalent regions, as the same has been described to have a high mortality. This abstract is funded by: mpme
Paulino et al. (Fri,) conducted a case report in Tuberculous Cardiac Tamponade (n=1). Emergent pericardiocentesis and rifampin-based four-drug regimen was evaluated on Symptomatic improvement and recurrence of pericardial effusion. Emergent pericardiocentesis and a 12-month rifampin-based four-drug regimen led to marked symptomatic improvement and no recurrence of pericardial effusion at 1 year in an 82-year-old man with tuberculous cardiac tamponade.