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Tuberculous Pericarditis, in an immunocompetent patient. Case Report
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Published:
Jan 1, 2021
Versions:
2021-01-01 (1)
Keywords:
Pericarditis, Tuberculosis, Adenosine Deaminase
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Abstract
Tuberculous pericarditis is a rare extrapulmonary manifestation that affects less than 4% of patients with tuberculosis (TB), with high morbidity and mortality in late diagnoses, especially in those immunocompromised patients. Its presentation is nonspecific and the symptomatology derives from the speed of installation of the pericardial effusion, registering fatal cases due to cardiac tamponade. Diagnostic confirmation is obtained with the identification of the mycobacterium in a sample of the pericardium or pericardial fluid, with a high suspicion rate based on additional tests such as quantification of non-stimulated gamma interferon, pericardial lysozyme and adenosine deaminase (ADA) in pericardial fluid. The treatment consist in a combination of antituberculous therapy, pericardial drainage, and corticosteroids as adjuvant. We present the case of a 64-year-old immunocompetent man, frequent smoker in the past, with a high diagnostic suspicion for TB, confirmed with a positive result for ADA (55,8 UI/L) in pericardial fluid, allowing to initiation of adequate treatment with subsequent clinical improvement during follow-up.
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How to Cite
Felipe-Reyes, D., Buitrago-Toro, K., Jiménez-Salazar, S., & Carlos-Alvarez, L. (2021). Tuberculous Pericarditis, in an immunocompetent patient. Case Report . Duazary, 18(1). https://doi.org/10.21676/2389783X.3834
Section
Clinical report
References
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19. Arroyo M, Soberman JE. Adenosine Deaminase in the Diagnosis of Tuberculous Pericardial Effusion. The American Journal of the Medical Sciences. 2008; 335(3):227-229. Doi: https://doi.org/10.1097/maj.0b013e3180cab71a
20. Koh KK, Kim EJ, Cho CH, Choi MJ, Cho SK, Kim SS, et al. Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis. Circulation. 1994; 89 (6): 2728-2735. Doi: https://doi.org/10.1161/01.cir.89.6.2728
2. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. (2010). Pericardial Disease: Diagnosis and Management. Mayo Clinic Proceedings. 2010; 85 (6): 572-593. Doi: https://doi.org/10.4065/mcp.2010.0046
3. Murray JF. A Century of Tuberculosis. American Journal of Respiratory and Critical Care Medicine. 2004; 169 (11):1181-1186. Doi: https://doi.org/10.1164/rccm.200402-140oe
4. Kekre NS, Sundaram M, Adhikary SD, John GT. Tuberculosis in renal transplant recipients. Indian Journal of Urology. 2008; 24 (3), 396. Doi: https://doi.org/10.4103/0970-1591.42625
5. Raviglione MC. Mycobacterial disease, En: Harrison’s Principles of Internal Medicine. EEUU: New York, 19th Editorial, McGraw-Hill Education; 2015. p.1111.
6. Echeverri D, Matta L. Pericarditis tuberculosa: reporte de caso. Biomédica. 2014; 34 (4): 528-534. Doi: https://doi.org/10.7705/biomedica.v34i4.2064
7. Chau E, Sarkarati M, Spellberg B. Adenosine Deaminase Diagnostic Testing in Pericardial Fluid. JAMA. 2019; 322(2):163. Doi: https://doi.org/10.1001/jama.2019.7535
8. Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis. JAMA. 2015; 314 (14), 1498-1506. Doi: https://doi.org/10.1001/jama.2015.12763
9. Organización Mundial de la Salud. Informe mundial sobre la tuberculosis 2019. Washington DC: OMS; 2019.
10. Aguilar JA, Summerson C, Montoya GE, González GG, Corvala JA, Godínez RJ, et al. Pericarditis tuberculosa: Experiencia de 10 años. Archivos de Cardiología de México. [revista en la Internet]. 2007 [citado 2020 Mayo 14]; 77:209-216. Disponible en: http://www.scielo.org.mx/pdf/acm/v77n3/v77n3a5.pdf
11. Ferrari SM, Garcia HL, Durón LP. Pericarditis tuberculosa: informe de caso. Rev. méd. Hondur. [revista en la Internet]. 2010 [citado 2020 Mayo 14]; 78(1): 25-28.Disponible en: http://www.bvs.hn/RMH/pdf/2010/pdf/Vol78-1-2010-9.pdf
12. Castañeda SE, Mejía JM. Valor del líquido pericárdico con relación a la biopsia pericárdica en el diagnóstico de pericarditis efusiva tuberculosa. Revista Médica Heredianat. [revista en la Internet]. 2000 [citado 2020 Mayo 14]; 11(4):122-129. Disponible en: http://www.scielo.org.pe/pdf/rmh/v11n4/v11n4ao2.pdf
13. Cegielski JP, Devlin BH, Morris AJ, Kitinya JN, Pulipaka UP, Lema LE, et al. Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis. Journal of Clinical Microbiology. [revista en la Internet]. 1997 [citado 2020 Mayo 14]; 35: 3254-3257. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC230157/pdf/353254.pdf
14. Amin-Beidokhty A, Norouzi Z, Amiri A, Almasian M, Azadi A, Kheirollahi AR. Pericardial tuberculosis with an emphasis on empiric therapy in endemic areas for tuberculosis (a case report). International Journal of Mycobacteriology. 2016; 5 (3), 360-365. Doi: https://doi.org/10.1016/j.ijmyco.2016.08.006
15. Reuter H, Burgess L, Van Vuuren W, Doubell A. Diagnosing tuberculous pericarditis. QJM, an International Journal of Medicine. 2006; 99 (12): 827-839. Doi: https://doi.org/10.1093/qjmed/hcl123
16. Maltezou HC, Spyridis P, Kafetzis DA. Extra-pulmonary tuberculosis in children. Archives of Disease in Childhood. 2000; 83(4): 342-346. Doi: https://doi.org/10.1136/adc.83.4.342
17. Clavería RC, Vergara GL, Negrón MS, López LC, Zelada PP, Carrasco OJ. Derrame Pericárdico, Enfrentamiento Clínico. Revista Chilena de Pediatría. [revista en la Internet]. 2009 [citado 2020 Mayo 14]; 80 (3): 267-273. Disponible en: https://www.revistachilenadepediatria.cl/index.php/rchped/article/view/2576
18. Yusuf SW, Hassan SA, Mouhayar E, Negi SI, Banchs J, O’Gara PT. Pericardial disease: a clinical review. Expert Review of Cardiovascular Therapy. 2016; 14 (4): 525-539. Doi: https://doi.org/10.1586/14779072.2016.1134317
19. Arroyo M, Soberman JE. Adenosine Deaminase in the Diagnosis of Tuberculous Pericardial Effusion. The American Journal of the Medical Sciences. 2008; 335(3):227-229. Doi: https://doi.org/10.1097/maj.0b013e3180cab71a
20. Koh KK, Kim EJ, Cho CH, Choi MJ, Cho SK, Kim SS, et al. Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis. Circulation. 1994; 89 (6): 2728-2735. Doi: https://doi.org/10.1161/01.cir.89.6.2728