Case Report - Current Trends in Cardiology (2017) Volume 1, Issue 2 The mystery of a deadly recurrent constrictive pericarditis: TB or not TB? Kenechukwu Mezue1*, Seyedhesamaldin Mostafavitoroghi1, Pradhum Ram1, Parasuram Krishnamoorthy2, Majorie Stanek2, Edwin Tulloch-Reid3 and Ernest Madu3 1Current Trends in Cardiology Abstract Constrictive pericarditis is characterized by scarring and loss of elasticity of the Pericardium, and subsequently, this leads to signs and symptoms of right heart failure. Common etiologies include previous cardiac surgery, repeated pericarditis, and Radiation therapy. However, less common causes include tuberculosis, neoplasms, and autoimmune disorders. Here we present a rare case of constrictive pericarditis of possible tuberculous etiology and review the diagnosis and management of the condition. Introduction Constrictive pericarditis is characterized by scarring and loss of elasticity of the pericardium, and subsequently, this leads to signs and symptoms of right heart failure. Common etiologies include previous cardiac surgery, repeated pericarditis, and radiation therapy. However, less common causes include tuberculosis, neoplasms, and autoimmune disorders. Here we present a rare case of constrictive pericarditis of possible tuberculous etiology and review the diagnosis and management of the condition. Case A 68-year-old female with a past medical history of hypertension, immune thrombocytopenia, and early cervical cancer (who had been cured surgically with a hysterectomy) presented with worsening shortness of breath on exertion and leg swelling of four weeks duration. She also had an occasional cough productive of whitish sputum. She has a history of contact with active tuberculosis (her father), and she was diagnosed with latent tuberculosis (TB) infection at an early age but did not complete a course of treatment for latent TB. The patient denied having chest pain, fever, and chills, weight loss, night sweat, or malaise. Her physical exam was remarkable for jugular venous distension, positive Kussmaul sign, hepatomegaly, and bilateral lower extremities edema. Initial labs were significant for thrombocytopenia with a platelet count of 15 000/cm3, B-type natriuretic protein (BNP) 270, international normalized ratio (INR) 1.3, alkaline phosphatase (ALP) 316, and total bilirubin 2.1 (direct bilirubin 1.1). Other lab values including haemoglobin levels, white blood cell count, renal function, and electrolytes were within normal limits. Her EKG showed low voltage QRS complexes in limb leads and T-wave inversion in anterior leads (Figure 1). HIV antibody screen and hepatitis panel were negative. PPD test was positive (15 mm) and chest X-ray showed bilateral pleural effusion and a calcified pericardium (Figures 2a and 2b). 1]. This will in turn cause dissociation between intra-thoracic and intra-cardiac pressures, increased inter-ventricular dependence causing a right-to-left septal shift, and increased diastolic filling pressures with pressure equalization in all four cardiac chambers [2].
