Lee Vivien Yan Chi, Wong John Tai Hung, Fan Hon Cheung, Yeung Vincent Tok Fai
Department of Family Medicine and Primary Health Care, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong.
BMJ Case Rep. 2012 Jun 28;2012:bcr0320125967. doi: 10.1136/bcr.03.2012.5967.
Tuberculous pericarditis is an exceedingly rare but a well-described extra-pulmonary manifestation of tuberculosis (TB) infection in Hong Kong. An 82-year-old woman with a known history of diabetes mellitus, hypertension and hyperlipidaemia was admitted for congestive heart failure. Routine echocardiographic study during admission revealed a massive pericardial effusion (~4 cm in thickness) but with no tamponade effect. Pericardiocentesis was performed and 1.6 L of heavily blood stained fluid was drained. All tumour and auto-immune markers were unremarkable. A whole body positron emission tomography-computer tomography (PET-CT) scan was then performed and showed an increased fluorodeoxyglucose uptake in the entire pericardium with no sources of possible malignancy identified. Rapid acid fast bacilli culture and Genprobe examination of the pericardial fluid then demonstrated the growth of Mycobacterium tuberculosis. She was started on anti-TB medications and tolerated them well. Follow-up echocardiographic study showed no re-accumulation of pericardial fluid.
结核性心包炎在香港是一种极为罕见但已有详细描述的肺结核感染肺外表现。一名82岁女性，有糖尿病、高血压和高脂血症病史，因充血性心力衰竭入院。入院时常规超声心动图检查发现大量心包积液（厚度约4厘米），但无心脏压塞效应。进行了心包穿刺，抽出1.6升重度血性液体。所有肿瘤和自身免疫标志物均无异常。随后进行了全身正电子发射断层扫描 - 计算机断层扫描（PET - CT），显示整个心包氟脱氧葡萄糖摄取增加，未发现可能的恶性肿瘤来源。心包液的快速抗酸杆菌培养和基因探针检查随后证实了结核分枝杆菌的生长。她开始接受抗结核药物治疗，耐受性良好。随访超声心动图检查显示心包积液未再积聚。
