Acute Large Pericardial Effusion With Haemodynamic Compromise Secondary to Undiagnosed Tuberculosis

Abstract

Tuberculous pericardial effusion is uncommon in the developed countries. However, it remains one of the main causes of presentation with a pericardial presentation with pericardial effusion in the developing world. We present the case of a 24-year-old male patient who presented with a weekly history of diarrhoea, vomiting, shortness of breath and feeling hot. Chest computed tomography revealed a large pericardial effusion with significant haemodynamic compromise. The patient underwent emergency pericardiocentesis, and the pericardial fluid interferon-gamma assay result was positive for tuberculosis. He was unable to tolerate endobronchial biopsy under ultrasound despite heavy sedation and was commenced on anti-tuberculous therapy following a discussion in a multidisciplinary team meeting. He was started on four standard anti-tuberculosis medications, including rifampicin, isoniazid, pyrazinamide, ethambutol and prednisolone. The patient had re-accumulation of pericardial fluid on repeat echocardiography in the first few weeks, which eventually resolved with anti-tuberculous therapy.

Keywords: : tuberculosis; anti-tuberculosis therapy; bronchoscopy; emergency pericardiocentesis; latent tb in the uk; pericardial effusion. cardiac tamponade; pericardial fluid analysis; rise of latent tb infection; systemic steroids; tuberculous pericardial effusion.

Figure 1. Chest radiography showing a globally increased cardiac shadow in keeping with significant pericardial effusion (yellow arrow).

Figure 2. Computed tomography scan of the abdomen and pelvis showing a large pericardial effusion (blue arrows).