Document Type : Case Report


1 Department of Cardiology,Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran



Tuberculous (TB) pericarditis is a well-known manifestation of tuberculosis, particularly in endemic regions. The progression to constrictive pericarditis, while under anti-tuberculosis treatment, is reported to be as high as 30%. This report presents a case of a 56-year-old female patient who complained of cough, pleuritic chest pain, night sweats, and fever, followed by orthopnea, dyspnea, and peripheral edema. Transthoracic echocardiography revealed the early stages of constrictive pericarditis and a small pericardial effusion. Chest computed tomography (CT) showed a thickened pericardium, small pericardial and pleural effusions, and multiple mediastinal lymphadenopathies. Due to a high suspicion of tuberculous pericarditis, the patient was administered empirical anti-TB treatment. A follow-up after two months showed complete resolution of symptoms and echocardiographic findings. Empirical antimicrobial treatment in endemic areas is a well-established strategy for managing tuberculous infection and proved successful in this patient. The early presentation and the significant improvement in signs and symptoms following the medical anti-TB regimen, without the need for pericardiectomy, were unique aspects of this case.


1. American Thoracic Society, Centers for Disease Control and Prevention. Diagnostic Standards and Classification of Tuberculosis in Adults and ‎Children. Am J Respir Crit Care Med 2000; 161(4 Pt 1): 1376-95.
2. Mayosi BM, Volmink JA, Commerford PJ, Yusuf S, Cairns JA, Camm AJ, et al. ‎Pericardial disease: an evidence-based approach to diagnosis and treatment. 2nd ed. 2003. p. 735-48.
3. Fowler NO. Tuberculous pericarditis. JAMA 1991; 266: 99-103.
4. Ortbals DW, Avioli LV. Tuberculous pericarditis. Arch Intern Med 1997; 139: 231.
5. Chang SA. Tuberculous and Infectious Pericarditis. Cardiol Clin 2017; 35(4): 615-22.
6. Ntsekhe M, Matthews K, Syed FF, Deffur A, Badri M, Commerford PJ, et al. ‎Prevalence, hemodynamics, and cytokine profile of effusive-constrictive pericarditis in patients with tuberculous pericardial effusion. PLoS One 2013; 8(10): e77532.
7. Mayosi BM, Ntsekhe M, Bosch J, Pandie S, Jung H, Gumedze F, et al. Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis. N Engl J Med 2014; 371(12): 1121-30.
8. Sreejith P, Kuthe S, Jha V, Kohli HS, Rathi M, Gupta KL, et al. Constrictive pericarditis in a renal transplant recipient with tuberculosis. Indian J Nephrol 2010; 20(3): 156-8.
9. Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial ‎diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36(42): 2921-64.
10. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous Pericarditis. Circulation 2005; 112(23): 3608-16.
11. Kushwaha S, Bogoch II, Mak S, Rogalla P, Detsky AS. In the Absence of Proof. N Engl J Med 2020; 383(19): 1878-84.
12. Lima NA, Lino D, Coelho NM, Melgar T. Tuberculous constrictive pericarditis. BMJ Case Reports CP 2019; 12: e230420.
13. Mathiasen VD, Frederiksen CA, Wejse C, Poulsen SH. A clinical case of tuberculosis with transient constrictive pericarditis and perimyocarditis. Echo Res Pract 2019; 6(3): K7-K12.
14. Catez E, Barbraud C, Hunter K, Strachinaru M. Atypical presentation of tuberculous constrictive pericarditis: case report and review of the literature. Acta Cardiol 2012; 67(3): 337-42.