CONGRESS ABSTRACT

Miliary tuberculosis (MT) is a life-threatening condition resulting from massive lympho- hematogenous dissemination of Mycobacterium tuberculosis from a focal lesion ruptured into the blood or lymphatic flow. It is commonly found in children, young adults and HIV-infected patients. Its diagnosis may be very challenging due to clinical polymorphism and lack of bacteriological proof in most cases. Mortality rate of TB pericarditis complications is up to 40%, emphasizing the importance of early diagnosis and management. A 19-year-old man presented with fever, dry cough, and constitutional symptoms for 2 weeks. The electrocardiogram showed low-voltage complexes, chest X-ray showed unspecific changes, and blood work revealed mild anaemia and a slight elevation of inflammatory parameters. An in-depth clinical and instrumental diagnostic work-up allowed to perform a diagnosis of miliary tuberculosis (MT) so he was admitted to Infectious Disease Unit and promptly received tetraconjugate management with an adequate clinical response. About three weeks later, he started complaining with worsening exertion fatigue and an increase in cardiothoracic index was noted on chest X-ray. Further imaging studies by CT and echocardiography revealed a moderate pericardial effusion (PE) without echocardiographic signs of hemodynamic instability. Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cardiac tamponade and 6% of constrictive pericarditis. The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis. Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol). Adjunctive corticosteroids may be beneficial in patients with tuberculous pericarditis. Close echocardiographic monitoring of pericardial effusion is mandatory to look for any signs of hemodynamic involvement that would require pericardiocentesis thus emphasizing the pivotal role of transthoracic echocardiography in the diagnosis and monitoring of cardiac involvement of MT. Follow-up echocardiographic assessment showed mild PE with no constrictive physiology. Increase in TB cases in non-endemic countries justify the need for a high clinical suspicion in order to ensure early diagnosis and treatment thus reducing complications and mortality of this disease.