Tuberculous pericarditis

An old acquaintance in an unusual site

Abstract

Tuberculous pericarditis is a rare but serious form of extrapulmonary tuberculosis. It is challenging to diagnose due to its nonspecific symptoms, requiring a combination of clinical findings, imaging techniques and laboratory tests. Direct microbiological confirmation is typically difficult.

We present two cases: an immunocompetent patient diagnosed indirectly through adenosine deaminase (ADA) testing, and an HIV immunocompromised patient with a positive molecular test of pericardial fluid. Both responded satisfactorily to antitubercular treatment.

Adenosine deaminase is a valuable tool that is quick and accessible when the presence of the bacillus cannot be proven by other means. Interferon gamma detection in pericardial fluid has shown an excellent diagnostic yield; however, this test has limited availability in our setting, as does pericardial tissue biopsy.