A 39-year-old patient with no prior medical visits presents with cardiac tamponade and undergoes urgent pericardiocentesis. He is from sub-Saharan Africa and has never been seen by a physician before—reports feeling progressively ill for the past month and brought to the hospital after syncopal episode today. Fluid analysis is performed and listed below:
The most likely etiology for the effusion would be:A. Tuberculous pericarditis
Tuberculous pericarditis. The patient presents with acute tuberculous pericarditis with large exudative effusion. Indolence of the effusion is likely over months; however, the salient findings in the fluid analysis are the elevated interferon gamma, ADA, and normal peripheral white blood cell count with pericardial lymphocyte predominance. The presence of interferon gamma elevation had a 92% sensitivity, 100% specificity, and 100% positive predictive value for tuberculous pericarditis. ADA was also linked to tuberculous pericarditis; however, it was not as sensitive or specific (87%/92%).
Although Answers b and c are epidemiologically possible, the fluid analysis is not suggestive of either. Pericardial biopsy (Answer d) is incorrect as tuberculous pericarditis can be defined by the interferon gamma and ADA elevation. Also Acid-Fast Bacilli (AFB) staining will reveal AFB + organisms confirming diagnosis. Biopsy should be reserved for patients with unrevealing fluid analysis who are still symptomatic and require further diagnostic testing to make a diagnosis.