Tuberculous Pericarditis Presenting as Cardiac Tamponade: Role of Echocardiography

Abstract

Tuberculous pericarditis, a rare but potentially lethal manifestation of tuberculosis, poses diagnostic and therapeutic challenges in clinical practice. Its nonspecific clinical presentation often mimics other conditions, leading to delayed or missed diagnoses. We report a 25-year-old male with no past medical history, who presented with nonspecific symptoms such as fatigue, weight loss, body aches, and dyspnea. An electrocardiogram showed low voltage QRS complex with electrical alternans, and transthoracic echocardiography (TTE) showed large pericardial effusion with tamponade physiology with right ventricular diastolic collapse, the collapse of the right atrium and the inferior vena cava was dilated with a respiratory variation of less than 50%. The diagnosis of tuberculous pericarditis was made based on clinical presentation, imaging, and laboratory findings, including a positive QuantiFERON-TB gold test and pericardial fluid analysis, despite negative cultures. This case highlights the significance of considering tuberculosis in the differential diagnosis of pericardial effusion and underscores the role of imaging and laboratory investigations in diagnosis. Management of tuberculous pericarditis involves a combination of antituberculous chemotherapy, pericardiocentesis, and corticosteroids. Despite its rarity, tuberculous pericarditis carries a high mortality rate and can present as cardiac tamponade, as illustrated in our case. This underscores the need for high clinical suspicion, especially in high-risk populations, for timely diagnosis and initiation of treatment.

A Case of Tubercular Pericardial Tamponade With Anti-tuberculosis Treatment-Induced Hepatitis

“…Our patient has no previous history of TB or TB contact, no underlying co-morbidities, and no history of trauma. In haemodynamically unstable patients, an emergency 2D-Echo should be done to rule out cardiac tamponade [ 7 ].…”

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…In Africa, pericardial diseases are most commonly caused by tuberculosis [111]. The development can lead to pericardial tamponade [111,112]. In a study from an endemic area, 53% of patients with pericardial effusions of 10 mm or more had tuberculous pericarditis; 45.5% were HIV-positive [113].…”