A Case Series of Pericardial TB in a large European Centre

Abstract

Introduction: Pericardial Tuberculosis (TB) is a rare manifestation of TB disease in high-income countries ( Methods: A retrospective analysis at a large European centre of all TB cases between 2005 – 2019 notified in the London TB register. Results: We identified 52 cases: 36.5% (19/52) were female, the mean age was 41.2 years (SD - 15.7 years) and 3.8% (2/52) were HIV positive. 51.9% (27/52) of cases presented with pericardial TB alone. 25% (13/52) cases underwent a pericardiocentesis whilst 11% (6/52) underwent a pericardial biopsy. Of the pericardial fluid sent just 15.3% (2/15) were M.TB culture positive whilst 16% (1/6) of the pericardial biopsies demonstrated necrotising granulomas. In 46% (24/52) there was no microbiological evidence of TB. Most cases (37/52) received 6 months of treatment, including 77.7% (21/27) of the cases of isolated pericardial TB. The remainder required extended courses for extra-pulmonary involvement (7/13) or resistant TB (2/13). 88.5% (46/52) completed treatment. 3.8% (2/52) terminated treatment prematurely and a further 3.8% (2/52) died. 5.7% (3/52) went on to develop constrictive pericarditis (of which 1 died) whilst a further 5.7% (3/52) developed cardiac tamponade (of which 1 died). Discussion: In low TB -incidence setting pericardial TB often presents as isolated disease. Available diagnostics remain of limited value and steroids remain a core component of therapy.