Mire Waberi Mohamud, Sheikh Hassan Mohamed, Hashi Mohamed Abdulrashid, Said Abdirahman, Akyuz Hakan
Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Ann Med Surg (Lond). 2022 Jul 31;80:104252. doi: 10.1016/j.amsu.2022.104252. eCollection 2022 Aug.
Pericarditis is a common illness that can appear in a variety of clinical settings and has numerous causes. In developing nations where tuberculosis is still a serious public health issue, more than 50% of cases of pericarditis are related to tuberculosis.
There was no history of TB, alcoholism, IV drug abuse, immunosuppressant, or corticosteroid use. On examination, she had a fever, tachycardia, pulsus paradoxus of 10 mmHg, hypotension, tachypnea, and a distended jugular vein. On auscultation, her heartbeats were muffled, and accompanied by a pericardial rub. Laboratory investigation showed low hematocrit and a high WBC count with lymphocyte predominance. ESR and CRP levels were elevated. Her chest X-ray revealed an enlargement of the cardiac silhouette. The ECG showed low voltage complexes. Echocardiography showed circumferential 30 mm × 25 mm pericardial effusion with fibrin strands in the visceral pericardium. An emergency pericardiocentesis was performed under the guidance of transthoracic echocardiography using sub-xiphoidal standards. Microbiologic analysis of the pericardial fluid confirmed tuberculosis. After successful pericardiocenthesis, the patient's condition improved massively. After three days of pericardiocentasis drainage, TB treatment was started and she was discharged for outpatient flow up.
Tuberculous pericarditis is a serious tuberculosis (TB) complication that can be difficult to diagnose and often goes undetected, leading to late complications such as constrictive pericarditis and cardiac tamponade, which lead to increased mortality. This current case illustrates a young female patient presenting with isolated TB pericarditis complicated by cardiac tamponade. She had massive improvement following pericardiocentesis and -TB treatment.
In Africa, tuberculous pericarditis should be considered as a differential diagnosis in any patient presenting with moderate to massive pericardial effusion. A high index of suspicion is required for the diagnosis of extrapulmonary TB pericarditis, especially in patients without known risk factors.
心包炎是一种常见疾病，可出现在多种临床情况下，病因众多。在结核病仍是严重公共卫生问题的发展中国家，超过50%的心包炎病例与结核病有关。
患者无结核病、酗酒、静脉注射吸毒、使用免疫抑制剂或皮质类固醇的病史。检查时，患者发热、心动过速、奇脉10 mmHg、低血压、呼吸急促、颈静脉怒张。听诊时，心音低沉，伴有心包摩擦音。实验室检查显示血细胞比容低，白细胞计数高，以淋巴细胞为主。血沉和C反应蛋白水平升高。胸部X线显示心影增大。心电图显示低电压复合波。超声心动图显示心包腔有30 mm×25 mm的环形积液，脏层心包有纤维条索。在经胸超声心动图引导下，采用剑突下标准进行了紧急心包穿刺术。心包液微生物分析确诊为结核病。成功进行心包穿刺术后，患者病情大幅改善。心包穿刺引流三天后，开始抗结核治疗，患者出院进行门诊随访。
结核性心包炎是一种严重的结核病并发症，可能难以诊断，常未被发现，导致诸如缩窄性心包炎和心脏压塞等晚期并发症，从而增加死亡率。本病例说明了一名年轻女性患者表现为孤立性结核性心包炎并伴有心脏压塞。心包穿刺术和抗结核治疗后她有了显著改善。
在非洲，对于任何出现中度至大量心包积液的患者，都应考虑结核性心包炎作为鉴别诊断。诊断肺外结核性心包炎需要高度的怀疑指数，尤其是在无已知危险因素的患者中。
