Tuberculous Pericarditis: Clinical, Diagnostic, and Therapeutic Features

Abstract

Introduction: Tuberculous pericarditis is a rare manifestation of extrapulmonary tuberculosis. Due to the infrequency of this condition, the most effective management approach has not been clearly established. Our study analyzed 14 cases with tuberculous pericarditis treated at Ibn Rochd Hospital in Casablanca over two years from 2020 to 2022. Methods: Medical records of tuberculous pericarditis patients were reviewed. Data on demographics, clinical presentation, diagnostic methods, and treatments were collected. Results were expressed in terms of frequencies, averages, and percentages. Results: The mean patient age was 37.7 years, with 64% males. Common symptoms included fever (50%), chest pain (57%), and dyspnea (92.8%). Clinical signs included right heart failure (35%) and muffled heart sounds (57%). ECG findings showed sinus tachycardia (71.4%) and low voltage (57%). Echocardiography revealed pericardial effusion (78%) and other abnormalities. Pericardial fluid was mostly citrine yellow (64%) and serohemorrhagic (36%). Adenosine deaminase was positive in 57% of cases. GeneXpert confirmed 71% of cases, while pericardial biopsy confirmed 29%. All received antitubercular treatment, with corticosteroids in three cases. In-hospital, 92% showed pericardial effusion regression, but one death due to tamponade occurred. Long term, 21% had effusion recurrence, and 35% transitioned to constrictive pericarditis. Conclusion: Tuberculous pericarditis presents diagnostic challenges. Clinical, radiological, and biological evidence is crucial for diagnosis. Antitubercular treatment is effective, but the risk of constrictive pericarditis remains high, necessitating further research into corticosteroid therapy's role in prevention.