A clinical case of tuberculosis with transient constrictive pericarditis and perimyocarditis

Tuberculous pericarditis is a rare diagnosis seen among as few as 1% of tuberculosis (TB) patients in developed countries. We present a case of a 60-year-old male suffering from a transient constrictive pericarditis and subclinical involvement of the myocardium in a clinical case of tuberculous pericarditis with corresponding improvement after the initiation of anti-tuberculous treatment. We suggest monitoring of myocardial function using global longitudinal strain by myocardial speckle tracking strain analysis as supplement to routine left ventricular ejection fraction to assess clinical improvement in patients at risk of developing constrictive pericarditis. Learning points: Tuberculous pericarditis is rare and a diagnostic challenge in low-incidence countries. Patients with tuberculosis and involvement of the heart are at high risk of developing constrictive pericarditis. Novel imaging techniques, such as estimation of global longitudinal strain using myocardial speckle tracking analysis, may be useful in assessing cardiac involvement in tuberculosis patients. Keywords: tuberculosis, perimyocarditis, constrictive pericarditis, echocardiography, global longitudinal strain Background Tuberculous pericarditis is a rare diagnosis seen among as few as 1% of tuberculosis (TB) patients in developed countries (1). The disease presents within the spectrum of acute pericarditis with or without larger effusions including cardiac tamponade and with subsequent development of chronic constrictive pericarditis (2). In Africa, Asia and other TB high-incidence regions, it is among the most common etiologies of pericarditis, constrictive disease and heart failure (3). The pericardial involvement in this condition is associated with a significant morbidity and mortality although the disease is potentially curable (4).