From Inflammation to Constriction: Tuberculous Pericarditis in a Young Postpartum Woman

Abstract

Tuberculous pericarditis remains a major cause of pericardial disease in endemic regions and continues to be associated with significant morbidity and mortality. Constrictive pericarditis represents one of its most severe complications and results from progressive pericardial inflammation leading to fibrosis, thickening, and impaired ventricular filling. We report the case of a 23-year-old pregnant woman who presented with febrile dyspnea and systemic inflammatory syndrome, whose clinical course was complicated by preterm labor and intrauterine fetal demise. Multimodal imaging revealed pericardial thickening, moderate pericardial effusion, respiratory variation of ventricular inflow velocities consistent with ventricular interdependence, and associated pleuropulmonary and lymph node involvement. Pleural fluid analysis demonstrated a lymphocyte-predominant exudate highly suggestive of tuberculous etiology in an endemic setting. Anti-tuberculous therapy combined with adjunctive corticosteroids was initiated promptly. This case highlights the diagnostic challenges of tuberculous constrictive pericarditis, particularly in young pregnant patients, and emphasizes the importance of early recognition of reversible inflammatory constriction to prevent progression toward irreversible fibrotic disease requiring pericardiectomy.