Refractory ascites as the only presenting symptom of chronic calcified constrictive pericarditis: a diagnostic challenge.

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

Mycobacterium bovis infection of an axillary-femoral bypass graft after intravesical bacille Calmette-Guérin immunotherapy for bladder cancer.

We report a case of bacillus Calmette-Guérin (BCG) infection of an axillary-femoral bypass graft presenting approximately 10 months after the initiation of intravesicular bacillus Calmette-Guérin for the treatment of bladder cancer. The patient's clinical course included removal of the bypass graft and antimycobacterial treatment with isoniazid, rifampin, and ethambutol for 9 months.

Tuberculous mycotic aneurysm of aortic root: an unusual cause of cardiac tamponade.

We describe a young male who presented to the emergency room with sudden onset dyspnea, and was found to have aortic root aneurysm with aortic regurgitation and cardiac tamponade. He underwent a Bentall procedure, and excised aortic root tissue showed epithelioid cell granulomas with panaortitis. He was started on anti-tubercular therapy, with which he improved. Although tubercular aortitis is fairly common, tuberculous mycotic aneurysm of the aorta is rare, with involvement of the aortic root being exceedingly uncommon. We report only the fifth case in English literature of tuberculous mycotic aneurysm of the aortic root.

Myocarditis and pericarditis with tamponade associated with disseminated tuberculosis.

Tuberculous involvement of the myocardium is relatively rare. Tuberculous pericarditis with tamponade and myocarditis in a young woman with no evidence of immunosuppression and disseminated tuberculosis is described. Three distinct forms of myocardial involvement are recognized: nodular tubercles (tuberculomas) of the myocardium; miliary tubercles of the myocardium; and an uncommon diffuse infiltrative type. The myocardium is involved by a hematogenous route, by lymphatic spread or contiguously from the pericardium. The diagnosis can be made by endomyocardial biopsy if clinical suspicion is strong and echocardiographic findings are suggestive. Antituberculosis drugs may be curative. With an increasing prevalence of tuberculosis, the possibility of potentially lethal myocardial tuberculosis is important to consider.

[The heart in tuberculosis]. / Il cuore nella tubercolosi.

The evolution of tuberculosis treatment considerably reduced the number of cases of pulmonary chronic heart with tubercular etiology. The fifteen cases of chronic cor pulmonale diagnosed at our Institute after tubercular disease are 22% of all cases of pulmonary chronic heart diagnosed in 1982. These cases are always combined with other diseases. Similar observations can be made about incidence of chronic constrictive pericarditis. Some progress was made in diagnosis of tuberculosis activity. Recent findings suggest not only that antimyolemmal antibodies are diagnostic indicators of perimyocardial involvement in tubercular pericarditis, but also that they may play a significant role in its pathogenesis.

[Cardiac lesions in generalized hematogenic tuberculosis]. / Porazhenie serdtsa pri generalizovannom gematogennom tuberkuleze.

A case of a generalized hematogenous tuberculosis with exacerbation in a woman of 62 is described. The disease had an undulating course and was manifested by a rare combination of miliary lung tuberculosis with extrapulmonal lesions. The latter included cavernous spondylitis with two paravertebral abscesses, fibrinous pericarditis and a large-focal lesion in the myocardium.

Tuberculous pericardial effusion after coronary artery bypass graft.

We describe a case of a recurrent pericardial effusion after coronary artery bypass grafting. This was initially considered to be due to post-pericardiotomy syndrome, but was later treated empirically as tuberculosis. After definitive surgery for this condition, pericardial histology and immunohistochemistry confirmed the diagnosis of tubercular pericarditis. At 4-months follow-up, while continuing anti-tuberculous therapy and corticosteroids, the patient showed consistent improvement without further recurrence of his pericardial effusion. Local reactivation of tuberculosis after pericardiotomy has not been previously reported and merits careful consideration in population groups in which tuberculosis is highly endemic.

Tuberculous aneurysm of the femoral artery: a complication of bacille Calmette-Guérin vaccine immunotherapy--a case report.

A case of bilateral femoral mycotic aneurysms resulting from bacille Calmette-Guérin vaccine, is reported in a 74-year-old man treated by intravesical immunotherapy. The diagnosis was made after histologic and bacteriologic examinations and biochemical analysis of the acid-fast-baccilli. Treatment consisted of resection and replacement of the femoral arteries, with an expanded polytetrafluoroethylene graft on the left side and a saphenous vein graft on the right side. After surgery the patient was treated with antituberculous chemotherapy for 1 year. The patient was doing well 18 months later.

Tuberculous aortoarteritis.

Tuberculous aortoarteritis is a distinct entity. Despite the still wide prevalence of active tuberculosis in developing countries, tuberculous aortoarteritis appears to be rare. The vessel is often involved by a direct extension of the disease from adjacent tuberculous tissue. Occasionally it may result from blood-borne seedlings from an active distant focus. True and false aneurysms are the common manifestations. Stenosing and/or constricting types of lesions and perivascular fibrosis have been encountered by us. The probable pathogenesis is discussed with illustrative cases.

Mycotic vascular infections of large arteries with Mycobacterium bovis after intravesical bacillus Calmette-Guérin therapy: case report.

Disseminated infection after intravesical bacille Calmette-Guérin instillation for bladder cancer is a rare but potential complication. Vascular infection is an additional serious complication but is seldom reported. We present the first report of a small series of patients with vascular infections after intravesical bacille Calmette-Guérin instillation, and we review the related literature.

Mycotic aneurysm of the popliteal artery as a complication of intravesical BCG therapy for superficial bladder cancer. Case report and literature review.

A 67-year-old man was treated with maintenance intravesical BCG for superficial bladder cancer. As a culture-proven complication of this therapy, he developed general malaise, high fever, granulomatous hepatitis and a mycotic aneurysm in his left knee. All complications were treated successfully with antituberculous therapy. No vascular surgery was necessary. This case report again stresses the necessity to recognise complications of BCG treatment and to start adequate therapy as soon as possible.