Title: Tubercular Pericarditis- A Case Series

Authors: Nasreen Ali, Sunil Kumar Agarwalla

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.136

Abstract

Tuberculosis is responsible for approximately 70% of cases of large pericardial effusion and most cases of constrictive pericarditis in developing countries. A definite or proven diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium. A probable or presumed diagnosis is based on proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated biomarkers of tuberculous infection, and/or appropriate response to a trial of antituberculosis chemotherapy. 

Here we report 3 cases of tubercular pericarditis of which 2 cases survived and one died due to cardiac arrest.

 The objectives of this case series is to emphasize that tuberculous pericarditis is a dangerous disease with a mortality of 17% to 40%; constriction occurs in a similar proportion of cases after tuberculous pericardial effusion. Early diagnosis and institution of appropriate therapy are essential to prevent mortality.

Keywords: Tuberculosis,pericardial effusion, antituberculosis chemotherapy.

References

1.      Fowler NO. Tuberculous pericarditis. Jama. 1991 Jul 3;266(1):99-103.

2.      Özvaran MK, Baran R, Tor M, Dilek I, Demiryontar D, Arinc S, Toker N, Chousein EU, Soğukpinar Ö. Extrapulmonary tuberculosis in non-human immunodeficiency virus-infected adults in an endemic region. Annals of thoracic medicine. 2007 Jul;2(3):118.

3.      Lorell BH, Braunwald E. Specific forms of pericarditis. Heart Disease. WB Saunders, Philadelphia,. 1988:1509-1.

4.      Gültekin F, Bakır M. Tuberculous pericarditis: A report of three cases. Current medical research and opinion. 2001 Jan 1;17(2):142-5.

5.      Siemann M, Rabenhorst G, Bramann A, Renk C. A case of cryptic miliary tuberculosis mimicking cholecystitis with sepsis. Infection. 1999 Jan 1;27(1):44-5.

6.      Osman M. Patterns Of Extra-Pulmonary Tuberculosis In Adult Sudanese Patients (Doctoral dissertation, UOFK).

7.      Schepers GW. Tuberculous pericarditis. The American journal of cardiology. 1962 Feb 1;9(2):248-76.

8.      DESA H. Tuberculous pericarditis. Cough. 1979 May 26;66:50.

9.      Friedland JS, Hartley JC, Hartley CG, Shattock RJ, Griffin GE. Inhibition of ex vivo proinflammatory cytokine secretion in fatal Mycobacterium tuberculosis infection. Clinical & Experimental Immunology. 1995 May 1;100(2):233-8.

10.  Tsao TC, Li L, Hsieh M, Liao S, Chang KS. Soluble TNFα receptor and IL1 receptor antagonist elevation in BAL in active pulmonary TB. European Respir-atory Journal. 1999 Sep 1;14 (3):490-5.

Corresponding Author

Nasreen Ali

Junior Resident, Department of Pediatrics,

M.K.C.G Medical College, Berhampur, Ganjam, Odisha-760004, India