Tuberculous Myopericarditis With Constrictive Physiology: A Case Report Using a Multimodality Approach - PubMed
5 hours ago
- #multimodality imaging
- #tuberculous pericarditis
- #constrictive physiology
- Tuberculous pericarditis is a rare but important cause of constrictive pericarditis in developed countries and remains a significant public health concern in endemic regions.
- A 47-year-old man presented with a five-year history of progressive bilateral lower-limb edema and exertional dyspnea, with severe fatigue and involuntary weight loss of 8 kg over the last five months.
- Imaging revealed biventricular systolic dysfunction, pericardial thickening with calcifications, and bilateral pleural effusions.
- Pleural fluid analysis showed exudative effusion with elevated adenosine deaminase (ADA) levels (130 U/L), consistent with tuberculous pleuritis.
- Cardiac magnetic resonance imaging confirmed myopericarditis with diffuse pericardial thickening (up to 6 mm) and late gadolinium enhancement.
- Right heart catheterization demonstrated findings consistent with constrictive physiology.
- Due to severe ventricular dysfunction, atrial fibrillation, and active extrapulmonary tuberculosis, pericardiectomy was deferred.
- Antituberculous therapy and guideline-directed medical treatment for heart failure were initiated.
- At three-month follow-up, the patient showed mild functional improvement and continued on a standard six-month antituberculous regimen.
- In endemic areas, tuberculosis should be considered an important cause of constrictive pericarditis in patients with unexplained pericardial disease.
- Multimodality imaging is essential for accurate diagnosis and guiding management, especially in complex presentations involving both the pericardium and myocardium.