Legorreta ASL, Niño OSK, Saldaña DY, Chavarría XP, Domínguez LR, Barrientos LE, Martínez CG, López RAC, Fuentes MEJ

Language: Spanish
References: 28
Page: 31-36
PDF size: 263.11 Kb.

ABSTRACT

Human Inmunodeficiency Virus HIV has changed TB epidemiology; there are 1 million people HIV-TB co-infected around the world increasing an extrapulmonary TB risk (ETB) and making more difficult an appropriate diagnosis. In México 5% of TB patients have HIV.
Case presentation. 38 years old single male, homosexual, HIV (+) with an evolution of low strain dyspnea, fever, cough with white sputum, asthenia, adynamia and weight loss of 10 kg. Blood pressure 100/60, heart rate 137, breath frequency 24, temp 37 °C, weight 70 kg, jugular ingurgitation II/III grade, diminished heart sounds, left pleural effusion of 80% and hepatomegaly, thorax X-ray: cardiomegaly, thoracic computed tomography: septate left pleural effusion linked to pericardium. Drainage done by Echocardiography: 1200 ml of purulent pericardial liquid, 60% polimorphonuclear and 40% mononuclear, 5 glucose, 25,583 lactate dehydrogenase, tuberculosis polymerase chain reaction positive and biological culture negative. A pericardial window was performed, pleurotomy and biopsy with necrosis. After 2 months in treatment with first line anti-tuberculous agents plus prednisone, with favorable evolution, residual pericardial effusion of 100 ml and no constrictive pericarditis signs.
Discussion. Despite new TB diagnosis techniques, ETB is still being a challenge by atypical presentation and lack of bacillary population. Treatment is still controversial, not only on the length but in the use of corticosteroids in HIV coinfected patients.

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