article · Cureus
Tuberculous pericarditis is a severe extrapulmonary condition that can cause pericardial effusion and constrictive physiology. Diagnosis remains challenging in young immunocompetent individuals who lack pulmonary symptoms. A clinical case of a twenty-year-old man presenting with constitutional symptoms and chest pain illustrates the diagnostic utility of combining multiple imaging modalities. Transthoracic echocardiography identified pericardial effusion alongside hallmarks of constrictive physiology, including septal bounce and respiratory variation in transmitral flow. Contrast-enhanced computed tomography confirmed diffuse pericardial thickening, while cardiac magnetic resonance revealed intense late gadolinium enhancement, demonstrating active pericardial inflammation. Diagnosis of tuberculosis was confirmed using an Xpert assay and mycobacterial culture of pericardial fluid. The patient was treated with an antituberculous regimen and corticosteroids, with planned reassessment for potential surgery, demonstrating how comprehensive imaging characterizes active inflammatory substrates that may be reversible.
Extrapulmonary tuberculosis can severely restrict heart function without displaying typical lung infection signs. Combining echocardiography, computed tomography, and magnetic resonance imaging enables clinicians to differentiate between permanent tissue scarring and active, potentially reversible inflammation. This precise characterisation helps medical teams decide whether intensive medication can resolve constriction or if invasive pericardiectomy surgery is required.
The abstract does not indicate a commercialisation pathway, as it presents a single clinical case report using existing diagnostic imaging equipment, molecular testing kits, and standard pharmaceutical regimens rather than developing a new product or platform.
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Tuberculous pericarditis (TBP) is a potentially severe manifestation of extrapulmonary tuberculosis that may lead to pericardial effusion and constrictive physiology and, in some patients, progress to fixed constrictive pericarditis.Diagnosis can be particularly challenging in young immunocompetent patients without overt pulmonary involvement.We report the case of a 20-year-old immunocompetent man presenting with a one-month history of weight loss, profuse night sweats, nocturnal fever, and typical pericarditic chest pain.Clinical examination revealed fever and signs of systemic venous congestion.Transthoracic echocardiography demonstrated marked pericardial thickening, moderate circumferential effusion, septal bounce, approximately 25% respiratory variation in transmitral flow, annulus reversus, and annulus paradoxus, supporting the presence of pericardial effusion with constrictive physiology.Contrastenhanced computed tomography confirmed diffuse pericardial thickening and effusion without calcification or pulmonary parenchymal involvement.At the same time, cardiac magnetic resonance demonstrated intense late gadolinium enhancement of the thickened pericardium, supporting active pericardial inflammation.Xpert Mycobacterium tuberculosis/Rifampicin assay (Xpert MTB/RIF; Cepheid, Sunnyvale, CA, USA) testing of the pericardial fluid detected Mycobacterium tuberculosis, subsequently confirmed by positive mycobacterial culture.Following multidisciplinary discussion, a six-month antituberculous regimen combined with adjunctive corticosteroid therapy was initiated, with close clinical and multimodality imaging follow-up and reassessment for pericardiectomy according to clinical evolution.This case highlights the complementary value of echocardiography, computed tomography, and cardiac magnetic resonance in characterizing tuberculous pericardial disease associated with constrictive physiology and defining its inflammatory substrate.Identification of active pericardial inflammation in the presence of constrictive physiology may indicate a potentially reversible component; however, actual reversibility requires confirmation during longer-term follow-up.
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DOI: 10.7759/cureus.115722
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