A case report of tuberculous constrictive pericarditis as a sole manifestation of tuberculosis in a male adolescent

  • Michael Jaya Siloam Heart Institute, Jakarta, Indonesia https://orcid.org/0000-0002-7406-4766
  • Arif Sejati Department of Internal Medicine, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Atma Jaya Hospital, Jakarta, Indonesia; Siloam MRCC Hospital Semanggi, Jakarta, Indonesia
  • Hariadi Hadibrata Siloam Heart Institute, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia
  • Leonardo Paskah Suciadi Siloam Heart Institute, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia https://orcid.org/0000-0001-8986-9068
Keywords: colchicine, complete pericardiectomy, constrictive pericarditis, right-sided heart failure, tuberculosis


Constrictive pericarditis is a rare type of pericardial disease that can be caused by various factors. Tuberculosis (TB) is one of the most common causes of this abnormality in Indonesia. Interestingly, tuberculous constrictive pericarditis can occur in the absence of acute pericarditis, pulmonary, or extrapulmonary TB. This case described a male adolescent with refractory right-sided heart failure symptoms who developed a rapidly progressive tuberculous constrictive pericarditis. Various imaging modalities, such as echocardiography, chest computed tomography (CT) scan, cardiac magnetic resonance imaging, and incidental PET/CT scan, were used to diagnose the pericardial abnormality. Histopathological findings in pericardial tissues confirmed the diagnosis. Complete surgical pericardiectomy, in conjunction with anti-TB drugs, diuretics, and colchicine, resulted in a significant clinical improvement.


Ragosta M. Textbook of clinical hemodynamics. Philadelphia: Elsevier; 2018. Chapter 9, Pericardial disease and restrictive myocardial diseases; p. 182-215. https://doi.org/10.1016/B978-0-323-48042-0.00009-9

Syed FF, Schaff HV, Oh JK. Constrictive pericarditis-a curable diastolic heart failure. Nat Rev Cardiol. 2014;11(9):530-44. https://doi.org/10.1038/nrcardio.2014.100

Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572-93. https://doi.org/10.4065/mcp.2010.0046

Gentry J, Klein AL, Jellis CL. Transient constrictive pericarditis: current diagnostic and therapeutic strategies. Curr Cardiol Rep. 2016;18(5):41. https://doi.org/10.1007/s11886-016-0720-2

Garcia MJ. Constrictive pericarditis versus restrictive cardiomyopathy? J Am Coll Cardiol. 2016;67(17):2061-76. https://doi.org/10.1016/j.jacc.2016.01.076

Depboylu BC, Mootoosamy P, Vistarini N, Testuz A, El-Hamamsy I, Cikirikcioglu M. Surgical treatment of constrictive pericarditis. Tex Heart Inst J. 2017;44(2):101-6. https://doi.org/10.14503/THIJ-16-5772

Bozbuga N, Erentug V, Eren E, Erdogan HB, Kirali K, Antal A, et al. Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival. Tex Heart Inst J. 2003;30(3):180-5.

Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev. 2014;27(1):3-20. https://doi.org/10.1128/CMR.00034-13

Tse G, Ali A, Alpendurada F, Prasad S, Raphael CE, Vassiliou V. Tuberculous constrictive pericarditis. Res Cardiovasc Med. 2015;4(4):e29614. https://doi.org/10.5812/cardiovascmed.29614

Welch TD, Oh JK. Constrictive pericarditis: old disease, new approaches. Curr Cardiol Rep. 2015;17(4):20. https://doi.org/10.1007/s11886-015-0576-x

Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005;112(23):3608-16. https://doi.org/10.1161/CIRCULATIONAHA.105.543066

Ministry of Health of Republic of Indonesia. The national guidelines for the treatment of tuberculosis. Ministry of Health of Republic of Indonesia; 2020. Indonesian.

Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, et al. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev. 2017;9(9):CD000526. https://doi.org/10.1002/14651858.CD000526.pub2

Mayosi BM, Ntsekhe M, Bosch J, Pandie S, Jung H, Gumedze F, et al. Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis. N Engl J Med. 2014;371(12):1121-30. https://doi.org/10.1056/NEJMoa1407380

Strang JI, Nunn AJ, Johnson DA, Casbard A, Gibson DG, Girling DJ. Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up. QJM. 2004;97(8):525-35. https://doi.org/10.1093/qjmed/hch086

Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-64. https://doi.org/10.1093/eurheartj/ehv318

Imazio M, Trinchero R, Brucato A, Rovere ME, Gandino A, Cemin R, et al. COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J. 2010;31(22):2749-54. https://doi.org/10.1093/eurheartj/ehq319

Telmesani A, Moss E, Chetrit M. The use of colchicine in pericardial diseases [Internet]. American College of Cardiology; 2019 [cited May 19 2021]. Available from: https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases.

Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43(8):1445-52. https://doi.org/10.1016/j.jacc.2003.11.048

Ghavidel AA, Gholampour M, Kyavar M, Mirmesdagh Y, Tabatabaie MB. Constrictive pericarditis treated by surgery. Tex Heart Inst J. 2012;39(2):199-205.

How to Cite
Jaya M, Sejati A, Hadibrata H, Suciadi L. A case report of tuberculous constrictive pericarditis as a sole manifestation of tuberculosis in a male adolescent. Med J Indones [Internet]. 2022Jun.28 [cited 2023Nov.30];31(2):120-5. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/5822
Case Report/Series