Tuberculous constrictive pericarditis of rapid progression and fatal

Abstract

Objective: To describe a case of fulminant tuberculosis constrictive pericarditis, highlighting its clinical, microbiological, imaging, and histopathological findings. Methodology: Observational, descriptive and retrospective study, consisting of a case report. The information was obtained from sources such as clinical records, laboratory tests, microbiological and imaging studies, among others. The antecedents were ordered chronologically and analyzed descriptively. A signed informed consent form was obtained. Development: A 28-year-old man with a history of harmful alcohol use and polysubstance use, as well as a chronic cervical abscess retrospectively considered suggestive of scrofula, presented with progressive ascites, peripheral edema, weight loss, night sweats, and dyspnea. Computed tomography revealed pericardial effusion, bilateral pleural effusions, and hepatic congestion. He was initially treated for presumed viral pericarditis but subsequently developed pulmonary thromboembolism, refractory shock, and acute respiratory failure requiring invasive mechanical ventilation and vasoactive support. Echocardiography demonstrated constrictive physiology and marked pericardial thickening. During thoracotomy, a loculated pericardial collection containing hemorrhagic and purulent material was identified. PCR testing of pericardial fluid was positive for Mycobacterium tuberculosis, and pericardial biopsy showed granulomatous inflammation. Despite surgical drainage and initiation of antituberculous therapy, the patient died. Discussion: The nonspecific clinical presentation and limited microbiological yield of pericardial specimens may delay the diagnosis of tuberculosis pericarditis. Constitutional symptoms, pericardial effusion, and evidence of extrapulmonary involvement should prompt early consideration of tuberculosis. Conclusion: Early integration of clinical, imaging, microbiological, and histopathological findings is essential for timely diagnosis and treatment. Nevertheless, advanced tuberculosis pericardial disease may follow a rapidly progressive and fatal course.