Moussa Chirine, Rouis Houda, Debbiche Soumaya, Khattab Amel, Khouaja Ibtihel, Zendah Ines, Maȃlej Sonia
Department 1 Abderrahamane Mami Hospital Ariana, Tunisia.
Heliyon. 2023 Apr 5;9(4):e15174. doi: 10.1016/j.heliyon.2023.e15174. eCollection 2023 Apr.
Tuberculous pericarditis (TBP) is one of the most important causes of pericarditis in developing countries in which tuberculosis remains a public health problem. We report the case of a 20-year-old immunocompetent woman who presented with hypotension and tachycardia echocardiography showed a massive pericardial effusion and signs of tamponade. The patient underwent an urgent pericardiocentesis; 700 ccs of serosanguinous pericardial fluid was drained. She had a surgical biopsy of the pleuropericardial window. The pathological examination confirmed TBP. Oral anti-tuberculosis therapy was initiated. Two months after therapy started, she was admitted for dyspnea and edema of the lower limbs. Echocardiography showed paradoxical inter-ventricular septum and non-compliant dilated inferior vena cava. She has been set on diuretics associated with Akurit for another two months. Thoracic CT scan done at 4 months of tuberculosis treatment showed: thickening of the pericardial layers, with an encysted collection facing the trunk of the pulmonary artery, bilateral pleural effusion, and thickening of the peribronchovascular and interlobular septa of the right lung, due to lymphatic stasis. We then switched to dual therapy for a total of eight months. An ultrasound check at the end of treatment was performed showing the absence of pericardial effusion with diminished systolic ejection fraction (54%). This case is the witness that TBP can be life-threatening even for immunocompetent patients. The risk is the evolution towards sequelae and constrictive pericarditis. The high mortality and morbidity from TBP despite the use of anti-tuberculous drugs call for research targeting host-directed immunological determinants of treatment outcome.
结核性心包炎（TBP）是发展中国家心包炎的最重要病因之一，在这些国家，结核病仍是一个公共卫生问题。我们报告了一例20岁免疫功能正常的女性病例，该患者出现低血压和心动过速，超声心动图显示大量心包积液和心包填塞征象。患者接受了紧急心包穿刺术，抽出了700毫升浆液血性心包积液。她接受了胸膜心包窗手术活检。病理检查确诊为TBP，遂开始口服抗结核治疗。治疗开始两个月后，她因呼吸困难和下肢水肿入院。超声心动图显示室间隔矛盾运动和下腔静脉扩张且顺应性降低。她继续使用利尿剂联合阿克立治疗两个月。抗结核治疗4个月时进行的胸部CT扫描显示：心包层增厚，肺动脉主干处有包裹性积液，双侧胸腔积液，右肺支气管血管周围和小叶间隔增厚，系淋巴淤滞所致。然后我们改为联合治疗，共持续8个月。治疗结束时进行的超声检查显示心包积液消失，但收缩期射血分数降低（54%）。该病例证明，即使对于免疫功能正常的患者，TBP也可能危及生命。风险在于发展为后遗症和缩窄性心包炎。尽管使用了抗结核药物，但TBP的高死亡率和高发病率仍需要针对治疗结果的宿主导向免疫决定因素进行研究。
