Internal Medicine University: ESIC MC and PGIMSR, Chennai, Tamilnadu, India.
Infectious Diseases, University of Texas Health, San Antonio, TX, 78229, USA.
BMC Infect Dis. 2024 Jan 15;24(1):86. doi: 10.1186/s12879-023-08941-2.
Extrapulmonary tuberculosis (EPTB) adds to India's significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries.
This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy.
This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
肺外结核病 (EPTB) 给印度带来了巨大的经济负担，心包积液是一种潜在的致命并发症。本病例报告强调了在发展中国家早期诊断和缩短 EPTB 治疗时间的必要性。
本病例报告描述了一名来自东南亚的 19 岁男性，他患有支气管扩张症，累及左下叶和右中叶，呈囊性，且多次发生非结核性肺炎。目前，他出现发热、低血压、心动过速和急性肾损伤。超声心动图显示左心室功能障碍，左心室射血分数（LVEF）为 45%，中度心包积液。注意到早期心脏压塞迹象，具体表现为右心室和左心室塌陷时无呼吸变化。紧急进行了心包穿刺，抽出血性心包积液。液体分析显示 LDH（5000 U/L）升高、多形核白细胞增多和显微镜下可见抗酸杆菌，这导致了心包结核的诊断。腹部 CT 显示肝脾肿大和多浆膜炎。经验性给予异烟肼、利福平、吡嗪酰胺和乙胺丁醇抗结核治疗 2 个月，然后再给予异烟肼和利福平治疗 4 个月。接下来几个月的连续超声心动图显示 LVEF（55%）改善和积液减少。然而，在治疗期间，由于肺炎频繁发作，对免疫缺陷疾病进行了评估，发现 IgG（4.741 g/L）、IgA（0.238 g/L）和 IgM（0.098 g/L）水平较低。他被诊断为常见可变免疫缺陷病，并接受了静脉注射免疫球蛋白治疗。
本报告强调了及时识别心脏压塞和通过缩短抗结核治疗时间有效管理 EPTB 的重要性，从而缓解了症状并改善了整体健康状况。
