A Case of Tuberculous Addison Disease With Recurrent Nontuberculous Pericarditis

Abstract

Objective: It is unknown if the combination of adrenal failure and acute pericarditis have a cause-effect relationship. Methods: A case report and literature review. Results: A 60-year-old man presented with acute pericarditis and adrenal failure. Bilateral adrenal swelling and a positive QuantiFERON test indicated adrenal tuberculosis. Analysis of pericardial effusion fluid indicated a nontuberculous and nonimmune etiology. Administration of stress doses of cortisol resolved the pericarditis. Antitubercular drugs were administered. One year after treatment, acute pericarditis and adrenal failure recurred following overwork. Administration of stress doses of steroid had an immediate effect on resolution of the pericarditis. Conclusion: Acute pericarditis is suspected as a symptom of adrenal failure. The recognition of this clinical presentation will help early diagnosis of adrenal failure and pericarditis. (AACE Clinical Case Rep. 2016;2:e199-e201

Acute Pericarditis as a Presentation of Adrenal Insufficiency

“…The recurrence of pericarditis is not rare; it occurs in 20 to 50% of cases of pericarditis and requires administration of immunosuppressive drugs [ 13 ]. Kawahara et al [ 14 ] published a case report of tuberculous Addison disease with recurrent nontuberculous pericarditis. There is a possibility that infection may have induced pericarditis with pericardial effusion and leading to adrenal insufficiency in our patient.…”

Addison’s disease presenting with perimyocarditis

“…Profoundly hypotensive Khalid [9] PGA 2 (AD + ATD) 48, female No Fatigue, malaise, sudden onset of left-sided chest pressure. Hypotensive Traficante [10] Newly diagnosed adrenoleukodystrophy Prenatal N/A Pericardial effusion was seen at a routine ultrasound examination Kawahara [11] (Table 1). It is unknown if the combination of adrenal failure and acute pericarditis has a direct cause-effect relation or if there exists a common etiological factor for the triggering of the adrenal destruction and the pericarditis [4].…”

“…More recently, pericarditis has been suggested to arise from chronic hypocortisolism, even in the absence of autoimmunity (in adrenoleukodystrophy [7,10], isolated ACTH deficiency [14] and tuberculous adrenalitis [11]). Considered together, these cases [7,10,11,14] indicate that a patient with adrenal failure can exhibit acute pericarditis with no obvious underlying immune mechanism.…”