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Abstract：
BACKGROUND: Extrapulmonary tuberculosis (EPTB) adds to India\'s significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries.
METHODS: This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy.
CONCLUSIONS: This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
METHODS: This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy.
CONCLUSIONS: This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
摘要：
背景：肺外结核（EPTB）增加了印度的重大经济负担，心包积液是潜在的致命并发症。该病例报告强调了发展中国家早期诊断的必要性和短期治疗EPTB的可行性。
方法：本病例报告描述了一名来自东南亚的19岁男性，他有累及左下叶和右中叶的支气管扩张史，本质上是囊性的，以及多次非结核性肺炎发作。目前,他出现了发烧，低血压,心动过速,和急性肾损伤。超声心动图显示左心室功能障碍，左心室射血分数（LVEF）为45％，中度心包积液。注意到心脏填塞的早期迹象，特别是右心室没有呼吸变异和左心室塌陷。紧急心包穿刺术,抽吸出血性心包液。流体分析显示LDH含量高（5000U/L），多形核白细胞增多症，和在显微镜下观察到的抗酸杆菌，这导致了心包结核的诊断。腹部CT显示肝脾肿大和多发性浆膜炎。根据经验,抗结核治疗包括异烟肼，利福平,吡嗪酰胺,给予乙胺丁醇2个月，随后4个月给予异烟肼和利福平。接下来几个月的连续超声心动图显示LVEF改善（55％）和积液减少。然而,在这个治疗期间，由于肺炎的频繁发作，进行了免疫缺陷疾病的评估，发现低水平的IgG（4.741g/L），IgA（0.238g/L），和IgM（0.098g/L）。他被诊断为常见的可变免疫缺陷疾病，并接受了静脉注射免疫球蛋白治疗。
结论：本报告强调及时识别心脏压塞，并通过比推荐疗程短的抗结核治疗有效治疗EPTB，从而减轻症状和更好的整体健康结果。
方法：本病例报告描述了一名来自东南亚的19岁男性，他有累及左下叶和右中叶的支气管扩张史，本质上是囊性的，以及多次非结核性肺炎发作。目前,他出现了发烧，低血压,心动过速,和急性肾损伤。超声心动图显示左心室功能障碍，左心室射血分数（LVEF）为45％，中度心包积液。注意到心脏填塞的早期迹象，特别是右心室没有呼吸变异和左心室塌陷。紧急心包穿刺术,抽吸出血性心包液。流体分析显示LDH含量高（5000U/L），多形核白细胞增多症，和在显微镜下观察到的抗酸杆菌，这导致了心包结核的诊断。腹部CT显示肝脾肿大和多发性浆膜炎。根据经验,抗结核治疗包括异烟肼，利福平,吡嗪酰胺,给予乙胺丁醇2个月，随后4个月给予异烟肼和利福平。接下来几个月的连续超声心动图显示LVEF改善（55％）和积液减少。然而,在这个治疗期间，由于肺炎的频繁发作，进行了免疫缺陷疾病的评估，发现低水平的IgG（4.741g/L），IgA（0.238g/L），和IgM（0.098g/L）。他被诊断为常见的可变免疫缺陷疾病，并接受了静脉注射免疫球蛋白治疗。
结论：本报告强调及时识别心脏压塞，并通过比推荐疗程短的抗结核治疗有效治疗EPTB，从而减轻症状和更好的整体健康结果。
