CASE REPORT Tuberculous pericarditis: a case report
Le Infezioni in Medicina
A lthough there has been a significant decline in tuberculosis in wealthy industrialized countries over last years, Africa, Asia, and Latin America with 86% of the world's population, are home to 95% of all cases of active tuberculosis and 98% of nearly two million deaths resulting from this disease each year . Tuberculous pericardi-tis, caused by Mycobacterium tuberculosis is found approximately in 1% of all autopsied cases of tuberculosis and in 1-2% instances of pulmonary tuberculosis
... Quick treatment of tuberculous pericarditis can be lifesaving. Effective treatment requires a rapid and accurate diagnosis for disease but it is frequently difficult . We report a case of tuberculous pericarditis in a 65-year-old man that was diagnosed by the posi-tivity of acid fast staining, culture and polymerase chain reaction (PCR) of the aspirated pericardial fluid, and promptly treated with antituberculosis drugs. n CASE REPORT A 65-year-old man patient presented with a 3-week history of fever with chills, non-productive cough and dyspnea. There were no history of tuberculosis, alcohol and IV drug abuse, certain diseases such as diabetes, cancer, and HIV infection , immunosuppression, use of corticosteroids and occupational risk (for example, health-care worker) as well as no familiar risk factors for tuberculosis. On examination he was febrile with temperature of 38.8°C, tachycardia (heart rate of 112 beats/min), blood pressure of 120/80 mmHg, and respiratory rate of 23 breaths/min. Jugular venous pulse was raised. The heart sounds were muffled and associated with a pericardial rub on auscultation. He had a body weight of 62 kg. Laboratory tests revealed haemoglobin of 12.4 g/dL, white blood cell count of 12000/mm 3 with polymorphs 60% and lymphocytes 37%, erythro-cyte sedimentation rate of 38 mm/h and C-reac-tive protein level of 4 mg/L (normal <5 mg/L). He was seronegative for HIV. The hepatic function tests were within normal limits. Creatinine level was 1.3 mg/dL. Tuberculin skin test (TST) was positive at 17 mm aftre 24 hours. Electrocar-diography (ECG) showed low voltage complex-Pericardial effusion is common disease and difficult to diagnose. Tuberculosis accounts for up to 4% of acute pericarditis and 7% of cardiac tamponade cases. Quick treatment can be lifesaving but requires accurate diagnosis. We report a case of a 65-year-old man who presented with a 3-week history of fever with chills, non-productive cough and dyspnea. SUMMARY The case was diagnosed by positivity of acid-fast staining , culture and polymerase chain reaction (PCR) of the aspirated pericardial fluid and treated promptly with antituberculosis drugs. The patient showed complete recovery.