"Fatal Hospital-Acquired Multidrug-Resistant Tuberculosis Pericarditis in" Two Patients With AIDS

Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.

"Fatal Hospital-Acquired Multidrug-Resistant Tuberculosis Pericarditis in" Two Patients With AIDS

New England Journal of Medicine (12/17/92) Vol. 327, No. 25, P. 1816
Horn, David L. et al.

Abstract: Clinicians should be aware of Mycobacterium tuberculosis infections involving both pulmonary and extrapulmonary sites, write David L. Horn et al. of the Lincoln Medical and Mental Health Center in Bronx, N.Y. Two patients at the medical center developed tuberculosis pericarditis. The first patient had AIDS and was hospitalized with fever and hypotention. He had had two previous hospitalizations for possible tuberculosis and had been treate0d with isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin but had not complied with therapy. Antituberculosis therapy was reinstituted. The patient became hypodic and required mechanical ventilation. Despite a pericardiotomy, the patient had a cardiac arrest and died. M. tuberculosis resistant to isoniazid, rifampin, ethambutol, and streptomycin but moderately susceptive to pyrazinamide was cultured from the sputum. An autopsy showed fibrinous pericarditis and miliary TB involving the lungs, spleen, kidneys, thyroid, lymph nodes, and pericardial tissue. The second patient also had AIDS and was hospitalized with fever and weight loss. Acid-fast bacilli were found on sputum smears, and the patient was treated with isoniazid, rifampin, pyrazinamide, and ethambutol. A pericardiotomy and biopsy were performed. A smear of pericardial fluid was negative for acid-fast bacilli. Hypotension persisted, and the patient died. Microscopial examination of the pericardial tissue revealed acid-fast bacilli, and M. tuberculosis was isolated from bone marrow, sputum, blood, and pericardial fluid. Multidrug-resistant TB was not detected in these patients before they died, therefore preventing effective therapy.

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