PERICARDIAL TB CAUSING RESTRICTIVE CARDIOMYOPATHY TREATED WITH RIFAMPIN, ISONIAZID, PYRAZINAMIDE, ETHAMBUTOL (RIPE) AND CORTICOSTEROIDS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pericardial tuberculosis presents in one to two percent of pulmonary (TB). Of these patients, approximately thirty sixty develop constrictive pericarditis without treatment. This case a patient with from reactivation prior pleural TB infection, treated RIPE therapy and adjunctive steroids. CASE PRESENTATION: An 81 year old male India history (treated isoniazid, para-aminosalicylic acid an unknown agent) recent diagnosis large pericardial effusion tamponade who presented dyspnea. On presentation, he was hemodynamically stable. Physical exam unremarkable. Labs significant for c-reactive protein 166 mg/L BNP 508 pg/mL. Echocardiogram showed small new pericarditis. Work up included heart catheterization, consistent physiology. Cardiac MRI revealed thickening, adhesions fibrosis. A thoracoscopy biopsy performed negative mycobacterium (MTB). Bronchoscopy bronchoalveolar lavage MTB, however induced sputum post-bronchoalveolar positive. He months followed by four Isoniazid Rifampin, addition prednisone 60 mg daily taper Bactrim Pneumocystis Jiroveci prophylaxis. After treatment initiation, testing negative. Repeat echocardiogram resolution constriction. The tolerated complications. DISCUSSION: Tuberculosis is diagnosed when any MTB detected the body setting In this case, underwent extensive workup which findings pericarditis, relation not established until his despite biopsy. Negative results cannot rule out as sensitivity ranges ten sixty-four percent. pericardiocentesis on initial presentation may have been helpful earlier diagnosis. Standard RIPE. However, role corticosteroids controversial. Research supports use patients or are at high risk developing These include those effusions, levels inflammatory cells fluid, and/or early signs Corticosteroids become standard due side effects, unclear benefits. CONCLUSIONS: rare challenging Recommended adjunct warrants further investigation. REFERENCE #1: Larrieu AJ, Tyers GF, Williams EH, Derrick JR. Recent experience tuberculous Ann Thorac Surg 1980; 29:464. #2: Komsuoglu B, Goldeli O, Kulan K, Komsuoaylu SS. diagnostic prognostic value adenosine deaminase Eur Heart J 1995; 16:1126. #3: Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers Disease Control Prevention/Infectious Diseases Society America Clinical Practice Guidelines: Treatment Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147. DISCLOSURES: No relevant relationships Adetokunbo Adebayo, source=Web Response Alissa Ali, Jared Beaudin, Julie Nguyen,