Tuberculous Constrictive Pericarditis in Immunocompetent Migrants From High-Incidence Countries: A Conservative Approach in a Low-Incidence Setting.

BACKGROUND

Although Italy is a low-incidence country, global migration patterns necessitate consideration of tuberculosis (TB), particularly extrapulmonary forms, in the differential diagnosis.

CASE PRESENTATIONS: We report 2 cases of tuberculous pericarditis in young, immunocompetent, HIV-negative men from high TB-incidence regions who were hospitalized at the Infectious Diseases Unit of Policlinico Umberto I, Rome. In both patients, the diagnosis of TB was made presumptively based on clinical presentation, positive immunological markers, and characteristic findings on multimodal imaging. Both patients had clinical and imaging evidence of constrictive pericarditis. A conservative medical approach was initiated, combining standard anti-TB therapy with prednisone 60 mg daily. This regimen led to significant clinical and hemodynamic improvement. One patient's course was complicated by a rare intracardiac tuberculoma, which also regressed with therapy.

CONCLUSIONS

Our cases demonstrate that a prompt, conservative approach to tuberculous pericarditis, confirmed by functional recovery and imaging findings, can lead to marked clinical and hemodynamic improvement, potentially obviating the need for invasive procedures or surgical intervention in selected patients.