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Am J Trop Med Hyg. Jul 10, 2013; 89(1): 1–2.
PMCID: PMC3748462
Pericardial Tuberculosis
Juan Carlos Cataño
Infectious Diseases Section, Internal Medicine Department, University of Antioquia Medical School and Fundacion Antioqueña de Infectologia, Medellin, Colombia
*Address correspondence to Juan Carlos Cataño, Infectious Diseases Section, Internal Medicine Department, University of Antioquia Medical School and Fundacion Antioqueña de Infectologia, Calle 15 Sur # 48 - 130, Medellin, Colombia. E-mail: kataju/at/hotmail.com
Received December 27, 2012; Accepted January 25, 2013.
A 53-year-old malnourished man, presented to the emergency room with 2 months of poor appetite, malaise, high spiking fevers, 10 Kg weight loss and night sweats; he also noted progressive exertional dyspnea and anterior chest pain developing over the last 2 days. On physical examination he was afebrile, had 90/60 arterial pressure, 100 × min heart rate, pulsus paradoxus, jugular vein engorgement, sudden inspiratory splitting of the second heart sound, and soft heart sounds on auscultation. A contrasted tomography of the thorax showed a large pericardial effusion with pericardial contrast enhancing and no pulmonary opacities. Histologic examination of pericardial tissue showed multinucleated giant cells with scarce acid-fast bacillae, and on pericardial culture grew Mycobacterium tuberculosis.
A 53-year-old malnourished man with no significant past medical history had worked his entire life as a farmer in rural Colombia. He went to a local emergency room because of 2 months of poor appetite, malaise, high spiking fevers, 10 Kg weight loss, and night sweats. He also had progressive exertional dyspnea and anterior chest pain for 2 days. On physical examination he was afebrile, arterial pressure 90/60, and heart rate 100/min. A pulsus paradoxus, jugular vein engorgement, soft heart sounds, and sudden inspiratory splitting of the second heart sound were found. A computed tomographic scan of the thorax showed a large pericardial effusion with pericardium contrast enhancing but no pulmonary opacities (Figures 1 and and22 ). A transthoracic echocardiography confirmed pericardial tamponade (Figures 3 and and44 ) that led to pericardiocentesis, which yielded 2,200 mL of reddish liquid with 5.9 gm/dL total protein; 2,300 leukocytes/mL (70% Lymphocytes); glucose 2 mg/dL; and an adenosine deaminase level of 234 U/L. Histologic examination of pericardial tissue showed granulomas with multinucleated giant cells (Figure 5 ) and scarce acid-fast bacillae (Figure 6 ); culture of pericardium grew Mycobacterium tuberculosis. A test for human immunodeficiency virus was negative. He was started on four antituberculosis medications plus Prednisone, and discharged 2 weeks after admission. Unfortunately, 2 months later he was readmitted because of constrictive pericarditis, and a pericardiectomy was performed. After 6 months of anti-TB therapy, the patient remained well.
Figure 1.
Figure 1.
Coronal view of thorax CT showing a large amount of pericardial effusion with pericardium contrast enhancing.
Figure 2.
Figure 2.
Axial view of thorax CT showing a large amount of pericardial effusion with pericardium contrast enhancing.
Figure 3.
Figure 3.
Transtoracic echocardiographic image of the heart showing a large pericardial effusion.
Figure 4.
Figure 4.
Transthoracic echocardiography showing the surface of the heart with a shaggy appearance, with frond-like structures extending to the parietal pericardium.
Figure 5.
Figure 5.
Histologic examination of pericardial tissue showing granulomas with multinucleated giant cells.
Figure 6.
Figure 6.
Ziehl-Neelsen stain showing scarce acid-fast bacillae.
Footnotes
Author's address: Juan Carlos Cataño, Infectious Diseases Section, Internal Medicine Department, University of Antioquia Medical School and Fundacion Antioqueña de Infectologia, Medellin, Colombia, E-mail: kataju/at/hotmail.com.
Articles from The American Journal of Tropical Medicine and Hygiene are provided here courtesy of
The American Society of Tropical Medicine and Hygiene