Pericardial and pulmonary tuberculosis: diagnostic, difficulties and impact

Abstract Introduction Tuberculosis (TB) is a global infectious disease caused by Mycobacterium tuberculosis (MTB), with high incidence worldwide. Although primarily affecting the lungs, TB can also involve the pericardium, leading to significant morbidity and mortality when diagnosis and treatment are delayed. Given the challenges of microbiological confirmation, a high index of clinical suspicion is crucial. Methods This was a retrospective observational study conducted at a cardiology referral hospital, analysing cases over a five-year period. Sixteen patients with both pericardial and pulmonary TB were identified. The diagnostic approach was based on a combination of clinical, laboratory and imaging criteria, including elevated adenosine deaminase (ADA) levels, polymerase chain reaction (PCR) for MTB and GeneXpert MTB/RIF testing. Imaging modalities such as echocardiography, computed tomography and magnetic resonance imaging assessed pericardial involvement. Results The cohort comprised 81% men and 18% women with a mean age of 51 years. The most prevalent comorbidities were hypertension (50%), type 2 diabetes mellitus (43%), chronic obstructive pulmonary disease (COPD) (37%) and silicosis (25%). Additionally, one patient was living with human immunodeficiency virus (HIV) and underwent the GeneXpert MTB/RIF test, which enabled rapid diagnostic confirmation. The main diagnostic methods were clinical-laboratory criteria and high ADA levels (75%). Patients with pericardial and pulmonary forms diagnosed within three months had better clinical outcomes, while those diagnosed later had more complications and a greater need for surgical intervention when pericardial involvement was present. Approximately 50% of patients with pericardial TB required surgical intervention, with better results seen in those who underwent pericardiectomy. The use of corticosteroids was beneficial in constrictive pericarditis, but did not prevent the persistence of symptoms in some patients. Discussion and Conclusions: The high rate of surgical intervention observed in this study underscores the severity of pericardial TB and highlights the importance of early recognition and diagnosis. Patients diagnosed at a later stage exhibited more extensive structural cardiac and pulmonary involvement, resulting in worse clinical outcomes. The use of GeneXpert MTB/RIF and PCR improved diagnostic accuracy and facilitated timely treatment initiation, particularly when these methods were readily available. These findings reinforce the need for a high index of clinical suspicion and an individualised management approach. Although corticosteroids were beneficial in some cases, persistent symptoms suggest their effectiveness may depend on the disease stage. Further studies with larger sample sizes are necessary to validate these findings and establish more precise clinical guidelines for pericardial TB.