Constrictive Pericarditis in Patient with Disseminated Isoniazid-Resistant Tuberculosis Without HIV Coinfection
Fecha
2022-05-12Autor
Resumen
Introduction: 1.4 million people died in the world from tuberculosis in 2019. Of these, 208,000 people were living with HIV. Themost common presentation is pulmonary tuberculosis, although distant organ involvement can be seen. A constant concern in thefight against tuberculosis is drug resistance. Description: We present the case of a 44-year-old male patient, without HIVinfection, with unintentional weight loss, dyspnea. Cardiac tamponade was documented, and he was taken to urgentpericardiocentesis with drainage of the pericardial fluid and early recurrence of the hemodynamic signs of obstructive shock. Inaddition, random micronodules were observed on chest tomography suggestive of miliary tuberculosis or Histoplasmosis, withassociated bronchiolitis and consolidations. Histoplasma urinary antigen was negative, and no acid-fast bacilli were found insputum. Simultaneously, a renal mass suspicious of malignancy or infection was documented. Due to the hemodynamic status, itwas not possible to perform bronchoscopy. Given the suspicion of disseminated tuberculosis, PCR was performed formycobacterium in urine, which was positive. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was started. Thepatient required subtotal pericardiectomy with adequate postoperative evolution. The PCR report for mycobacterium tuberculosisof pericardial fluid was positive, with the presence of resistance to isoniazid due to KATG and INHA mutation. Moxifloxacin wasadded to antituberculous management
Abstract
Introduction: 1.4 million people died in the world from tuberculosis in 2019. Of these, 208,000 people were living with HIV. Themost common presentation is pulmonary tuberculosis, although distant organ involvement can be seen. A constant concern in thefight against tuberculosis is drug resistance. Description: We present the case of a 44-year-old male patient, without HIVinfection, with unintentional weight loss, dyspnea. Cardiac tamponade was documented, and he was taken to urgentpericardiocentesis with drainage of the pericardial fluid and early recurrence of the hemodynamic signs of obstructive shock. Inaddition, random micronodules were observed on chest tomography suggestive of miliary tuberculosis or Histoplasmosis, withassociated bronchiolitis and consolidations. Histoplasma urinary antigen was negative, and no acid-fast bacilli were found insputum. Simultaneously, a renal mass suspicious of malignancy or infection was documented. Due to the hemodynamic status, itwas not possible to perform bronchoscopy. Given the suspicion of disseminated tuberculosis, PCR was performed formycobacterium in urine, which was positive. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was started. Thepatient required subtotal pericardiectomy with adequate postoperative evolution. The PCR report for mycobacterium tuberculosisof pericardial fluid was positive, with the presence of resistance to isoniazid due to KATG and INHA mutation. Moxifloxacin wasadded to antituberculous management
Keywords
URI
http://repositorio.mederi.com.co/handle/123456789/672https://www.atsjournals.org/doi/epdf/10.1164/ajrccm-conference.2022.205.1_MeetingAbstracts.A4935
Colecciones
- Investigación clínica [389]