Document Type

Conference Proceeding

Publication Date

5-2-2025

Abstract

Tuberculous (TB) pericarditis is a rare yet serious form of extrapulmonary tuberculosis, characterized by a diverse clinical presentation and the potential to occur as an isolated extrapulmonary manifestation. In developed countries, tuberculosis is a rare cause of pericarditis, contributing to less than 5% of pericardial effusion cases and an even smaller percentage of constrictive pericarditis cases. This case describes a 27-year-old male from Mali with no significant medical history presenting with progressive fatigue, shortness of breath, and palpitations over one year. Family history revealed sudden cardiac death in his father in his 30s. Physical examination and initial investigations, including echocardiography, revealed dilated cardiomyopathy with moderate global hypokinesis, a left ventricular ejection fraction of approximately 40%, and fibrinous material in the pericardial space. Computed tomography (CT) demonstrated tree-in-bud opacities and mediastinal lymphadenopathy with necrosis, suggestive of an infectious process. Cardiac magnetic resonance imaging (MRI) revealed marked pericardial thickening (up to 2.2 cm) with features of active inflammation and constrictive physiology. A definitive diagnosis of tuberculous pericarditis was established following positive cultures for Mycobacterium tuberculosis complex obtained via bronchoscopy. The patient was initiated on a four-drug RIPE regimen: rifampin, isoniazid, pyrazinamide, and ethambutol, along with vitamin B6 supplementation. Tuberculous pericarditis accounts for approximately 1% of all tuberculosis cases and can progress to constrictive pericarditis in 30–60% of treated patients. Early diagnosis, prompt antitubercular therapy, and close monitoring are critical in preventing complications such as cardiac tamponade or chronic constriction. This case underscores the importance of considering TB in all patients regardless if they are living in endemic areas presenting with unexplained pericardial disease. Advanced imaging modalities such as CT and MRI are invaluable in evaluating atypical pericardial conditions and differentiating between constrictive and non-constrictive processes. Multidisciplinary management and clinician awareness is essential for recognition and optimization of patient outcomes.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter Resident and Medical Student Day, May 2, 2025, Troy, MI

Download

Included in

Radiology Commons

Share

COinS