# A Case of Tubercular Pericardial Tamponade With Anti-tuberculosis Treatment-Induced Hepatitis

## TL;DR

This case study describes a patient with tuberculosis-related pericardial tamponade who also developed liver damage from anti-tuberculosis treatment.

## Contribution

The paper presents a rare clinical case of TB-induced pericardial tamponade complicated by drug-induced hepatitis.

## Key findings

- Pericardial fluid testing confirmed Mycobacterium TB using ADA and CBNAAT.
- The patient developed ATT-induced hepatitis requiring modified treatment.
- The patient showed clinical improvement after treatment adjustments.

## Abstract

Pericarditis can be a common complication of tuberculosis (TB) in developing countries like India. It is associated with fever, fatigue, and weight loss and can often be accompanied by shortness of breath and chest pain. Other common causes of pericardial effusion include malignancy, renal failure, autoimmune disease, and viral and bacterial infections. When the pericardial fluid is bloody, TB is likely to be present in developing countries. It can often get complicated with cardiac tamponade, which has a high mortality rate.

We present a case of a 55-year-old female with no co-morbidities who presented with shortness of breath, fatigue for two weeks, and chest pain for one week. She had no history of fever, chills, or rigour, and no history of TB contact. Clinical examination revealed low blood pressure with raised jugular venous pressure (JVP). Her electrocardiography (ECG) showed sinus tachycardia with a low-voltage complex. Echocardiography (ECHO) showed a large pericardial effusion, compromising ventricular function. We performed pericardiocentesis, drained 1.4 L of bloody fluid, and sent the pericardial fluid for analysis. Pericardial fluid adenosine deaminase (ADA) and cartridge-based nucleic acid amplification testing (CBNAAT) came positive for Mycobacterium TB. The patient was started on anti-tubercular treatment (ATT) and broad-spectrum antibiotics with drainage. Other routine investigations and autoimmune immune workups were normal. The patient also developed ATT-induced hepatitis, for which modified ATT was initiated. The patient improved clinically and symptomatically, was discharged, and was advised to follow up in the outpatient department (OPD).