Pericardial effusion in an eleven-year old girl with HIV and tuberculosis

Sarah Pujiasri, Elsa Maimon

Dr. Kanujoso Djatiwibowo Hospital, Balikpapan – Indonesia

ABSTRACT

Background
Pericarditis caused by M. tuberculosis is rare, occurring in about 1% of tuberculosis cases.
Despite the rarity of pericarditis in developed countries, the disease is still found in
immunocompromised patients and in areas where tuberculosis remains as major public health
problems. The combination of clinical judgement, chest X-ray, and Mantoux test was helpful in
establishing the diagnosis. Affected patients often develop large pericardial effusions and cardiac
tamponade. The pathognomonic finding is pericardial friction rub. Echocardiographic
examination of heart and its surroundings are determining diagnostic tools.
Objective
To present a rare case which pericardial effusion caused by tuberculosis possibility has been
overlooked.
Case
A severely malnourished 11-year-old female presented to the emergency room with shortness of
breath. She was fully conscious who experienced tachycardia and tachypnea with distended
jugular veins, murmur heart sound at the apex, pericardial friction rub, hepatomegaly, and pitting
edema of the lower extremities. X-ray showed cardiomegaly and pulmonary infiltrate. An
echocardiographic test indicated pericardial effusion. Laboratory examination showed normal
WBC count with thrombocytopenia, elevated AST and ALT, hypoalbuminemia and
hyponatremia. Her Mantoux skin test was negative but HIV test was positive. Her past medical
history showed a history of tuberculosis treatment. The patient was treated with ampicillin,
digoxin, and corticosteroids. Treatment for tuberculosis was commenced using isoniazid,
rifampin, pyrazinamide, ethambutol and streptomycin.
Conclusion
The study showed that pericardial effusion could happen in an immunocompromised and
tuberculosis patient.
Keywords
Tuberculosis, pericardial effusion