PMID- 33204984
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220418
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 4
IP  - 5
DP  - 2020 Oct
TI  - Bulky granulomatous disease resulting in constrictive tuberculous pericarditis 
      requiring pericardiectomy: a case report.
PG  - 1-6
LID - 10.1093/ehjcr/ytaa208 [doi]
AB  - BACKGROUND: We present a 23-year-old Nepalese migrant with mycobacterial 
      tuberculosis (TB) pericarditis manifesting as effusive constrictive disease and 
      subsequent rapid progression to constrictive pericarditis resulting from bulky 
      granulomatous disease. CASE SUMMARY: Following initial presumptive diagnosis of 
      TB pericarditis based on presence of moderate pericardial effusion and positive 
      polymerase chain reaction on concurrent pleural aspirate, the patient was managed 
      with standard empiric therapy. Despite treatment, he developed progressive heart 
      failure with New York Heart Association (NYHA) class III symptoms and had 
      confirmation of constrictive physiology on simultaneous left and right heart 
      catheterization. He underwent pericardiectomy 4 months after his initial 
      diagnosis, with debridement of large necrotizing granulomas and an associated 
      immediate improvement clinical improvement. He remains well at 6-month follow-up 
      with no residual heart failure symptoms off diuretic therapy. DISCUSSION: 
      Tuberculous pericarditis accounts for 1-2% of presentations with TB infection, 
      with progression to constrictive pericarditis in between 17 and 40% of cases. To 
      date, pericardiectomy remains mainstay of treatment for constriction, albeit with 
      high perioperative risk. In combination with anti-tuberculous therapy, prednisone 
      and pericardiocentesis may reduce risk of progression to constriction, however, 
      neither have shown mortality benefit. Our patient continued to progress, despite 
      medical therapy and proceeded to pericardiectomy only 4 months after his initial 
      diagnosis, with rapid improvement in symptoms, demonstrating the importance of 
      close monitoring and revision of management strategy in these patients.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Barua, Sumita
AU  - Barua S
AUID- ORCID: 0000-0001-9091-6773
AD  - Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, 
      Australia.
FAU - Phua, Bernadette
AU  - Phua B
AUID- ORCID: 0000-0003-1140-1726
AD  - Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, 
      Australia.
FAU - Orr, Yishay
AU  - Orr Y
AD  - Department of Cardiothoracics, Westmead Hospital, Hawkesbury Road, Westmead NSW 
      2145, Australia.
FAU - Skinner, Michael
AU  - Skinner M
AD  - Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, 
      Australia.
LA  - eng
PT  - Case Reports
DEP - 20200927
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC7649499
OTO - NOTNLM
OT  - Case report
OT  - Constrictive pericarditis
OT  - Granulomatous disease
OT  - Pericardiectomy
OT  - Tuberculous pericarditis
EDAT- 2020/11/19 06:00
MHDA- 2020/11/19 06:01
PMCR- 2020/09/27
CRDT- 2020/11/18 06:01
PHST- 2020/02/20 00:00 [received]
PHST- 2020/03/17 00:00 [revised]
PHST- 2020/06/05 00:00 [accepted]
PHST- 2020/11/18 06:01 [entrez]
PHST- 2020/11/19 06:00 [pubmed]
PHST- 2020/11/19 06:01 [medline]
PHST- 2020/09/27 00:00 [pmc-release]
AID - ytaa208 [pii]
AID - 10.1093/ehjcr/ytaa208 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2020 Sep 27;4(5):1-6. doi: 10.1093/ehjcr/ytaa208. 
      eCollection 2020 Oct.