Lidyawati Mulyo1, Prayudi Santoso2, Arto Yuwono Soeroto2
1Departement of Internal Medicine
2Divison of Pulmonology and Critical Respiration, Department of Internal Medicine
Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin Hospital
Jl. Pasteur No.38, Bandung

Abstract

Tuberculosis (TB) is one of the infectious diseases with the highest prevalence which causes high mortality worldwide. Although rarely found, TB pericarditis can be life threatening because it can cause pericardial effusion which, if left untreated, can cause death due to cardiac tamponade. A 44 years old man presented with cardiac tamponade with clinical appearance of Tb, but pericardial fluid analysis favored bacterial pericarditis. Pericardial fluid analysis showed fluid glucose was 4, fluid protein was 5.320, LDH was 3.781, yellow, cloudy, cell count: 1.716, polymorphonuclear (PMN) 85,2, mononuclear (MN) 14,8. Patient then diagnosed with severe pericardial effusion with sign of tamponade due to bacterial pericarditis with differential diagnosis was tuberculous pericarditis. On the 4th day of treatment, it was found out from the results of GenXpert that there was Mycobacterium tuberculosis in the pericardial fluid with increased Adenosine deaminase (ADA) level, and Chest X-ray showed milliary TB. The patient was then given category 1 anti-tuberculosis drug and methylprednisolone 40 mg. The diagnosis of TB pericarditis is challenging, it requires knowledge about its pathogenesis and thorough analysis in its diagnosis. Not only depending on one tool, but still clinical assessment and confirmation with definite diagnostic tools such as culture or histopathology.
Keywords: bacterial pericarditis, diagnosis, pericardial fluid, PMN, tuberculous pericarditis