Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://jmc.elmerpub.com

Case Report

Volume 16, Number 4, April 2025, pages 146-152

Double Trouble in the Pericardium: A Rare Co-Infection of Tuberculosis and Tularemia Leading to Cardiac Tamponade

Figures

Figure 1.
Figure 1. Computed tomography scan of the chest. Large bilateral pleural effusions with adjacent atelectasis and scattered pulmonary nodules (red arrows).
Figure 2.
Figure 2. Computed tomography scan of the chest. (a) Enlarged lymph node within the anterior mediastinum measuring up to 1.0 cm in the short axis with central hypodensity concerning for necrosis (red arrow). (b) An enlarged retro-crural lymph node measuring up to 0.9 cm in the short axis (red arrow).
Figure 3.
Figure 3. Transthoracic echocardiography and mitral inflow velocities at pulsed wave Doppler. (a) Transthoracic echocardiogram showing anterior pericardial effusion. RV diastolic collapse was seen, indicating tamponade physiology. (b) Pulsed wave Doppler showing exacerbated mitral inflow respiratory variance.
Figure 4.
Figure 4. Retroperitoneal lymph node biopsy. A hematoxylin and eosin-stained section of a retroperitoneal lymph node core biopsy showing granulomatous necrotizing lymphangitis.
Figure 5.
Figure 5. Summary chart of events. A flowsheet to summarize the patient’s hospitalization.

Table

Table 1. Causes of Granulomatous Disease [25, 26]
 
CategoryDiagnoses
InfectiousMycobacterial (Mycobacterium tuberculae, Mycobacterium leprae)
Bacterial (Treponema pallidum, Bartonella henselae, Brucella, Francisella tularensis, Listeria monocytogenes, Chlamydia trachomatis, Nocardia)
Fungal (Histoplasma capsulatum, Coccidioides spp., Blastomyces dermatitidis, Cryptococcus neoformans)
Autoimmune and inflammatorySarcoidosis, Crohn disease, granulomatosis with polyangiitis, primary biliary cholangitis, Churg-Strauss syndrome
MalignancyHodgkin and non-Hodgkin lymphoma
Exposure inducedBeryllium and silicone exposure, hypersensitivity pneumonitis
ImmunodeficiencyChronic granulomatous disease