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Tuberculous Pericarditis

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Presented in part April 3, 1968, at the Forty-Ninth Annual Session of the American College of Physicians, held in association with the Royal College of Physicians of London, in Boston, Mass.

▸Requests for reprints should be addressed to John J. Rooney, M.D., Department of Medicine, State University of New York Downstate Medical Center, 450 Clarkson Ave., Brooklyn, N. Y. 11203

Brooklyn, New York

Ann Intern Med. 1970;72(1):73-78. doi:10.7326/0003-4819-72-1-73
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Tuberculous pericarditis is difficult to diagnose and treat and is associated with a 40% mortality. Of 35 patients with tuberculous pericarditis 6 (17%) were undiagnosed antemortem. Two groups among the 28 patients who received chemotherapy were compared: 10 patients treated with "triple therapy" alone and 18 patients treated with "triple therapy" and prednisone. Both groups were comparable in age, race, sex, and extent and duration of disease. Four patients in the first group died. Four patients required pericardiectomy, two of these improved, and two died. Four of the remaining 6 patients improved, and two died. One of the improved patients has since required pericardiectomy 5 years after initial treatment. There were no deaths in the second group; 14 improved without surgery, and 4 required adjunctive pericardiectomy. Cardiovascular complications of the inflammatory exudate in the pericardium are the major causes of death in tuberculous pericarditis. Corticoids suppress inflammation, enhance reabsorption of the effusion, and appear essential for successful therapy. Pericardiectomy is indicated for persistent enlarged heart size, progressive congestive heart failure, and increasing venous pressure when heart size is decreasing.





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