A Case of Tuberculous Pericarditis: A Rare but Deadly Disease

医学 心包炎 结核性心包炎 皮肤病科 内科学
作者
Emil Lou,George L. Adams
出处
期刊:The American Journal of Medicine [Elsevier BV]
卷期号:119 (8): e1-e2
标识
DOI:10.1016/j.amjmed.2005.12.030
摘要

A 64 year-old homeless alcoholic man presented to the hospital with abdominal pain, 15-lb weight loss, fatigue, and shortness of breath. He denied any past medical or social history, and further review of systems was negative.Objectively, he was a cachectic, chronically ill-appearing gentleman. He was afebrile and normotensive but tachycardic with a pulsus paradoxus. His chest had decreased breath sounds bilaterally. Cardiovascularly, he had distant heart sounds, otherwise normal. His abdominal examination was benign.Laboratory tests were notable for a white blood count of 3.0, a negative human immunodeficiency virus (HIV) test, 2 sets of negative blood cultures, and a negative lumbar puncture. An electrocardiogram (ECG) showed sinus tachycardia with low voltage and diffuse inverted T waves. A chest radiograph was remarkable for cardiomegaly and bilateral pleural effusions.A computed tomography (CT) scan of the chest revealed a large pericardial effusion (5.0 cm in diameter), bilateral pleural effusions, and extensive mediastinal lymphadenopathy. Subsequently, a transthoracic echocardiogram (TTE) evaluating for cardiac tamponade confirmed a large pericardial effusion with respiratory flow variation and prominent fibrinous tissue adherent to the visceral pericardium (Figure 1, Figure 2).Figure 2Short-axis view on transthoracic echocardiogram.View Large Image Figure ViewerDownload (PPT)Surgical drainage of the pericardial effusion and a pericardial window were performed. The pericardium was found to be thick and inflamed; 1500 mL of bloody fluid was drained from the pericardial space. Fluid cytology was negative. Pathology results revealed necrotizing granulomatous inflammation of the pericardial tissue with histochemical stains detecting rare acid-fast bacilli. The patient was empirically started on isoniazid, rifampin, pyrazinamide, pyridoxine, and ethambutol, as well as a course of slow-taper prednisone, and continued on this regimen for 12 months following confirmation of pericardial tuberculosis.DiscussionTuberculosis is a global health problem. It currently infects approximately one-third of the world’s population and kills approximately 2 million individuals annually.1World Health OrganizationGlobal Tuberculosis Control. World Health Organization, Geneva, Switzerland2005Google Scholar Pericarditis caused by tuberculosis is rare, occurring in approximately 2% of US pericardectomy patients but is a dangerous disease with mortality rates reported between 20% and 40%. Causes of pericarditis can be divided into infectious and noninfectious etiologies. Among the most common noninfectious causes include malignancies, such as lung cancer or lymphomas, radiation therapy, sarcoidosis, or collagen vascular diseases. Infectious etiologies include bacteria such as Staphylococcus, Streptococcus, or E. coli; viruses such as echovirus, adenovirus, coxsackieviruses, HIV; or other agents such as Treponema pallidum.2Nardell E.A. Fan D. Shepard J.A. Mark E.J. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2004. A 30-year-old woman with a pericardial effusion.N Engl J Med. 2004; 351: 279-287Crossref PubMed Scopus (6) Google Scholar Tuberculosis is one of the least common causes of infective pericarditis.Diagnosis of tuberculous pericarditis has improved in recent years, although no diagnostic study is accurate, safe, and easy to perform. TTE has been proposed as a way to differentiate tuberculosis from chronic idiopathic pericardial effusions, taking into consideration the degree of pericardial thickening and presence of exudates and strands in the pericardial space.3George S. Salama A.L. Uthaman B. Cherian G. Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion.Heart. 2004; 90: 1338-1339Crossref PubMed Scopus (22) Google ScholarManagement and treatment of tuberculous pericarditis with a hemodynamically significant pericardial effusion involves surgical pericardial window placement or pericardiocentesis, as well as antitubercular medications. The use of corticosteroids as an adjuvant treatment has been explored with promising results. Two randomized trials in Transkei, South Africa, where tuberculous pericarditis is common, involved the use of prednisolone versus placebo in addition to standard tuberculosis regimen and possible pericardial drainage in patients with either effusion or constrictive pericarditis. After a 10-year follow-up, the use of prednisolone resulted in a higher rate of clinical improvement from pericarditis, as well as reducing the need for further pericardial drainage and improving survival.4Strang J.I. Nunn A.J. Johnson D.A. Casbard A. Gibson D.G. Girling D.J. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei results at 10 years follow-up.QJM. 2004; 97: 525-535Crossref PubMed Scopus (75) Google Scholar A 64 year-old homeless alcoholic man presented to the hospital with abdominal pain, 15-lb weight loss, fatigue, and shortness of breath. He denied any past medical or social history, and further review of systems was negative. Objectively, he was a cachectic, chronically ill-appearing gentleman. He was afebrile and normotensive but tachycardic with a pulsus paradoxus. His chest had decreased breath sounds bilaterally. Cardiovascularly, he had distant heart sounds, otherwise normal. His abdominal examination was benign. Laboratory tests were notable for a white blood count of 3.0, a negative human immunodeficiency virus (HIV) test, 2 sets of negative blood cultures, and a negative lumbar puncture. An electrocardiogram (ECG) showed sinus tachycardia with low voltage and diffuse inverted T waves. A chest radiograph was remarkable for cardiomegaly and bilateral pleural effusions. A computed tomography (CT) scan of the chest revealed a large pericardial effusion (5.0 cm in diameter), bilateral pleural effusions, and extensive mediastinal lymphadenopathy. Subsequently, a transthoracic echocardiogram (TTE) evaluating for cardiac tamponade confirmed a large pericardial effusion with respiratory flow variation and prominent fibrinous tissue adherent to the visceral pericardium (Figure 1, Figure 2). Surgical drainage of the pericardial effusion and a pericardial window were performed. The pericardium was found to be thick and inflamed; 1500 mL of bloody fluid was drained from the pericardial space. Fluid cytology was negative. Pathology results revealed necrotizing granulomatous inflammation of the pericardial tissue with histochemical stains detecting rare acid-fast bacilli. The patient was empirically started on isoniazid, rifampin, pyrazinamide, pyridoxine, and ethambutol, as well as a course of slow-taper prednisone, and continued on this regimen for 12 months following confirmation of pericardial tuberculosis. DiscussionTuberculosis is a global health problem. It currently infects approximately one-third of the world’s population and kills approximately 2 million individuals annually.1World Health OrganizationGlobal Tuberculosis Control. World Health Organization, Geneva, Switzerland2005Google Scholar Pericarditis caused by tuberculosis is rare, occurring in approximately 2% of US pericardectomy patients but is a dangerous disease with mortality rates reported between 20% and 40%. Causes of pericarditis can be divided into infectious and noninfectious etiologies. Among the most common noninfectious causes include malignancies, such as lung cancer or lymphomas, radiation therapy, sarcoidosis, or collagen vascular diseases. Infectious etiologies include bacteria such as Staphylococcus, Streptococcus, or E. coli; viruses such as echovirus, adenovirus, coxsackieviruses, HIV; or other agents such as Treponema pallidum.2Nardell E.A. Fan D. Shepard J.A. Mark E.J. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2004. A 30-year-old woman with a pericardial effusion.N Engl J Med. 2004; 351: 279-287Crossref PubMed Scopus (6) Google Scholar Tuberculosis is one of the least common causes of infective pericarditis.Diagnosis of tuberculous pericarditis has improved in recent years, although no diagnostic study is accurate, safe, and easy to perform. TTE has been proposed as a way to differentiate tuberculosis from chronic idiopathic pericardial effusions, taking into consideration the degree of pericardial thickening and presence of exudates and strands in the pericardial space.3George S. Salama A.L. Uthaman B. Cherian G. Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion.Heart. 2004; 90: 1338-1339Crossref PubMed Scopus (22) Google ScholarManagement and treatment of tuberculous pericarditis with a hemodynamically significant pericardial effusion involves surgical pericardial window placement or pericardiocentesis, as well as antitubercular medications. The use of corticosteroids as an adjuvant treatment has been explored with promising results. Two randomized trials in Transkei, South Africa, where tuberculous pericarditis is common, involved the use of prednisolone versus placebo in addition to standard tuberculosis regimen and possible pericardial drainage in patients with either effusion or constrictive pericarditis. After a 10-year follow-up, the use of prednisolone resulted in a higher rate of clinical improvement from pericarditis, as well as reducing the need for further pericardial drainage and improving survival.4Strang J.I. Nunn A.J. Johnson D.A. Casbard A. Gibson D.G. Girling D.J. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei results at 10 years follow-up.QJM. 2004; 97: 525-535Crossref PubMed Scopus (75) Google Scholar Tuberculosis is a global health problem. It currently infects approximately one-third of the world’s population and kills approximately 2 million individuals annually.1World Health OrganizationGlobal Tuberculosis Control. World Health Organization, Geneva, Switzerland2005Google Scholar Pericarditis caused by tuberculosis is rare, occurring in approximately 2% of US pericardectomy patients but is a dangerous disease with mortality rates reported between 20% and 40%. Causes of pericarditis can be divided into infectious and noninfectious etiologies. Among the most common noninfectious causes include malignancies, such as lung cancer or lymphomas, radiation therapy, sarcoidosis, or collagen vascular diseases. Infectious etiologies include bacteria such as Staphylococcus, Streptococcus, or E. coli; viruses such as echovirus, adenovirus, coxsackieviruses, HIV; or other agents such as Treponema pallidum.2Nardell E.A. Fan D. Shepard J.A. Mark E.J. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2004. A 30-year-old woman with a pericardial effusion.N Engl J Med. 2004; 351: 279-287Crossref PubMed Scopus (6) Google Scholar Tuberculosis is one of the least common causes of infective pericarditis. Diagnosis of tuberculous pericarditis has improved in recent years, although no diagnostic study is accurate, safe, and easy to perform. TTE has been proposed as a way to differentiate tuberculosis from chronic idiopathic pericardial effusions, taking into consideration the degree of pericardial thickening and presence of exudates and strands in the pericardial space.3George S. Salama A.L. Uthaman B. Cherian G. Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion.Heart. 2004; 90: 1338-1339Crossref PubMed Scopus (22) Google Scholar Management and treatment of tuberculous pericarditis with a hemodynamically significant pericardial effusion involves surgical pericardial window placement or pericardiocentesis, as well as antitubercular medications. The use of corticosteroids as an adjuvant treatment has been explored with promising results. Two randomized trials in Transkei, South Africa, where tuberculous pericarditis is common, involved the use of prednisolone versus placebo in addition to standard tuberculosis regimen and possible pericardial drainage in patients with either effusion or constrictive pericarditis. After a 10-year follow-up, the use of prednisolone resulted in a higher rate of clinical improvement from pericarditis, as well as reducing the need for further pericardial drainage and improving survival.4Strang J.I. Nunn A.J. Johnson D.A. Casbard A. Gibson D.G. Girling D.J. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei results at 10 years follow-up.QJM. 2004; 97: 525-535Crossref PubMed Scopus (75) Google Scholar
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
传奇3应助momo采纳,获得10
刚刚
1秒前
胡图图发布了新的文献求助10
2秒前
4秒前
蜜HHH完成签到 ,获得积分10
5秒前
6秒前
6秒前
我要文献发布了新的文献求助10
7秒前
7秒前
7秒前
量子星尘发布了新的文献求助10
10秒前
暴躁小龙发布了新的文献求助10
11秒前
张润泽完成签到 ,获得积分10
11秒前
12秒前
文档发布了新的文献求助10
12秒前
13秒前
15秒前
16秒前
16秒前
17秒前
18秒前
18秒前
烟花应助zwk采纳,获得10
20秒前
蔡芝艳关注了科研通微信公众号
20秒前
YI完成签到,获得积分10
23秒前
23秒前
大个应助科研通管家采纳,获得10
24秒前
24秒前
充电宝应助科研通管家采纳,获得10
25秒前
SYLH应助科研通管家采纳,获得20
25秒前
Ava应助科研通管家采纳,获得10
25秒前
丘比特应助科研通管家采纳,获得10
25秒前
情怀应助科研通管家采纳,获得10
25秒前
Hello应助科研通管家采纳,获得10
25秒前
Owen应助科研通管家采纳,获得10
25秒前
25秒前
su发布了新的文献求助10
27秒前
钟垠州完成签到 ,获得积分10
27秒前
27秒前
活力的妙之完成签到 ,获得积分10
27秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989297
求助须知:如何正确求助?哪些是违规求助? 3531418
关于积分的说明 11253893
捐赠科研通 3270097
什么是DOI,文献DOI怎么找? 1804884
邀请新用户注册赠送积分活动 882087
科研通“疑难数据库(出版商)”最低求助积分说明 809158