SHM Converge Scientific Abstract ePoster Gallery-Eptb and Cvid: Is 6 Months of Therapy Enough?

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This case report describes a 19-year-old South Asian male with a history of bilateral bronchiectasis and recurrent pneumonia who presented with fever, cough, vomiting, and shock. Bedside echocardiography revealed moderate pericardial effusion with reduced left ventricular ejection fraction. Analysis of hemorrhagic pericardial fluid showed very high LDH, polymorphonuclear leukocytosis, and acid-fast bacilli, confirming pericardial tuberculosis. Although adenosine deaminase was low, the diagnosis was supported by microbiologic findings.<br /><br />The patient was treated with standard antitubercular therapy: isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months. At 6 months, serial echocardiograms showed improvement in ejection fraction and reduction in effusion. He was later diagnosed with common variable immunodeficiency (CVID) and started on intravenous immunoglobulin every 3 weeks. At 24 months, he remained asymptomatic.<br /><br />The discussion emphasizes that pericardial effusion in TB-endemic regions should raise strong suspicion for tuberculous pericarditis, as cardiac tamponade can be fatal if not recognized early. Echocardiography is important for identifying tamponade features, while serum LDH may be a useful biomarker in resource-limited settings. ADA is often used to support extrapulmonary TB diagnosis, but it was not elevated in this patient.<br /><br />The report highlights that the optimal duration of therapy for extrapulmonary TB, especially tuberculous pericarditis, remains debated. However, this case supports the effectiveness of 6 months of standard antitubercular therapy even in an immunocompromised patient with CVID.

Asset Subtitle

Husna Qadeer

Meta Tag

Author List Ankur Singla, Barath Prashanth Sivasubramanian, Diviya B. Ravikumar, Husna Qadeer, Rakshaya Venu, Saketh Shekar

Category Clinical Vignettes

Concept Extrapulmonary Tuberculosis

Concept Pericardial Tuberculosis

Concept Pericardial Effusion

Concept Cardiac Tamponade

Concept Multidrug Antitubercular Therapy

Distinguished Non-Finalist

Presenter Organization ESIC Medical College KK Nagar Chennai

Presenting Author Husna Qadeer

Track Adult

Keywords

tuberculous pericarditis

pericardial effusion

cardiac tamponade

acid-fast bacilli

antitubercular therapy

common variable immunodeficiency

echocardiography

adenosine deaminase

extrapulmonary tuberculosis

bronchiectasis

Extrapulmonary Tuberculosis

Pericardial Tuberculosis

Pericardial Effusion

Cardiac Tamponade

Multidrug Antitubercular Therapy