Article Text


  1. L. Tom
  1. Orange, CA.


Introduction Constrictive pericarditis is a rare complication of Mycobacterium tuberculosis and can present as a diagnostic dilemma in sputum AFB negative and tuberculin skin test negative patients.

Case Presentation A 44 year-old Vietnamese female was admitted to the intensive care unit with congestive heart failure and pericardial effusion where she underwent successful pericardiocentesis. A full diagnostic evaluation for infection, connective tissue disorder, and neoplasm was negative at that time. She also had a pleural effusion that was drained, sent for appropriate cultures, and sputa for AFB that were negative. Her HIV test and tuberculin skin test were negative. She was treated with diuresis, nonsteroidal anti-inflammatory agents and was discharged home after symptomatic improvement. The patient returned with Class III heart failure and had a cardiac catheterization demonstrating pericardial constriction. The decision was made to take the patient for pericardial stripping given her recurrent effusion and constrictive physiology. While undergoing the surgical procedure, a small amount of pus was noted emanating from the pericardial sac. Appropriate cultures were sent including gram stain, bacterial culture and AFB. AFB subsequently was positive and confirmatory tests were positive for Mycobacterium tuberculosis. Post operatively, the patient's symptoms improved. She was started on four drug therapy for Mycobacterium tuberculosis. After she was discharged, her sputum and pleural effusion cultures from the initial hospitalization returned positive for Mycobacterium tuberculosis.

Discussion Mycobacterium tuberculosis rarely presents as constrictive pericarditis in the United States(1). With delay in diagnosis, pericarditis can lead to right heart failure, cardiac tamponade, and death. Pericardial fluid culture, tissue for AFB, or granulomas are required for diagnosis(2).

Cegielski JP, Lwakatare J, Dukes CS, et al. Tuber Lung Dis 1994; 75:42934.Trautner BW, Darouiche RO Clin Infect Dis. 2001 Oct 1;33(7):954-961.

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