A case of acute tuberculous pericarditis evolving into pericardial constriction after 32 years: A case report

Background Chronic constrictive pericarditis (CCP) is a rare condition. Pathophysiologically, it is characterized by inflammation and morphological changes of the pericardium leading to a presentation of adiastole. Etiologies are multiple, and tuberculosis remains a frequent cause in developing countries. Multimodal imaging has revolutionized the diagnosis of chronic constrictive pericarditis, and effective treatment remains pericardial decortication followed by etiological treatment whenever possible. Case presentation: We report the case of a 55-year-old female patient who presented with dyspnea and signs of right heart failure evolving in a context of asthenia. Transthoracic echocardiography and thoracic CT scan helped to diagnose chronic constrictive pericarditis, with tuberculosis as the suspected etiology based on the patient's history. The patient was initially treated medically, but due to persistent signs of systemic congestion, a diagnostic and therapeutic pericardial decortication was performed. Histopathological examination of the operative specimen confirmed Mycobacterium tuberculosis infection. Conclusion Chronic constrictive pericarditis is a rare but serious condition. Clinical presentation can vary from chronic fatigue to a refractory right-sided heart failure. Tuberculosis remains a relevant pathology in developing countries and should therefore always be suspected even in the context of previously treated tuberculosis. Pericardiectomy remains the gold standard in the effective management of this condition.