Dr. Huynh Thanh Kieu, Head of Cardiology Department 1 at Tam Anh General Hospital in Ho Chi Minh City, states that tuberculosis bacteria can attack not only the lungs but also invade the pericardium, the membrane surrounding the heart, leading to severe complications.

Following a Covid-19 infection, Nga continued to experience a low-grade fever each afternoon. He began to feel breathless when climbing stairs, had an abnormally fast heart rate, and difficulty breathing, prompting him to seek medical attention at Tam Anh General Hospital in Ho Chi Minh City.

Upon admission, Nga's heart rate reached 170 beats per minute, significantly higher than the normal range of 60-100 beats per minute. An echocardiogram confirmed pericardial effusion accompanied by pleural effusion.

Since pericardial effusion can stem from tuberculosis, cancer, autoimmune diseases, or infections, doctors performed chest and abdominal CT scans, which showed no lesions. However, analysis of the pericardial fluid after aspiration revealed Mycobacterium tuberculosis, confirming pericardial tuberculosis.

Dr. Hoang Thi Binh, from Cardiology Department 1 at Tam Anh General Hospital in Ho Chi Minh City, explained that pericardial tuberculosis is an extrapulmonary form of tuberculosis. While it accounts for approximately 1% of all tuberculosis cases, it is a dangerous form of the disease. When tuberculosis bacteria invade the membrane around the heart, the inflammatory response causes fluid to accumulate. If left untreated, the heart becomes compressed, reducing its ability to pump blood and potentially leading to heart failure.

According to Dr. Binh, Nga's case likely involved a pre-existing latent tuberculosis infection that reactivated when his immune resistance decreased.

Dr. Binh checks on the patient before discharge. *Photo: Tam Anh General Hospital*

The patient underwent pericardial and pleural fluid drainage to relieve pressure on his heart, along with a standard antituberculosis drug regimen. After nearly three weeks, he was fever-free, no longer experienced shortness of breath, had a good appetite, and was discharged. He will continue antituberculosis medication for at least six months as directed by his doctor.

Pericardial tuberculosis often progresses silently with non-specific symptoms, making it easily mistaken for other cardiovascular or respiratory conditions. Common manifestations include persistent low-grade fever, chest pain, shortness of breath, a rapid heart rate, fatigue, weight loss, and pericardial effusion.

Dr. Kieu emphasized that tuberculosis remains prevalent in Vietnam. Therefore, all cases of unexplained pericardial effusion require investigation for pericardial tuberculosis. At Tam Anh General Hospital in Ho Chi Minh City, patients receive coordinated consultations from Respiratory and Cardiology specialists. After an echocardiogram detects pericardial effusion, doctors may order CT scans and pericardial fluid tests using molecular biology techniques to quickly identify tuberculosis bacteria, ensuring accurate treatment.

If detected early and treated according to the full regimen, the prognosis for pericardial tuberculosis is generally good, with a low risk of recurrence. Conversely, incomplete treatment or an immunocompromised state can increase the likelihood of recurrence.

To prevent the disease, doctors recommend getting the BCG vaccine as advised, screening for latent tuberculosis in high-risk groups, and seeking immediate medical attention for persistent symptoms such as fever, fatigue, shortness of breath, or unexplained chest pain.

Thu Ha

*Patient's name has been changed