Avoiding pericardiectomy: a case report of successful medical management for tuberculous constrictive pericarditis in the peripartum period

Tuberculous pericarditis (TBP) is a rare but lethal peripartum complication, often masked by physiological gestational changes. Transient constrictive pericarditis represents a reversible inflammatory phenotype that can resolve with medical therapy, potentially avoiding high-risk surgical intervention.

A 22-year-old postpartum female presented with acute respiratory distress and was diagnosed with miliary tuberculosis. Echocardiography confirmed classic constrictive physiology. The patient was diagnosed with a transient constrictive phenotype and managed with a standard four-drug antituberculous regimen, oral prednisone (1 mg/kg), and diuretics. Following intensive medical treatment, she achieved complete clinical and haemodynamic resolution, avoiding the need for pericardiectomy. At 6-month follow-up, she remained asymptomatic with normalized echocardiographic parameters.

This case highlights the importance of distinguishing the transient inflammatory phase of TBP from chronic constriction in the peripartum period. Using echocardiographic criteria and initiating prompt, targeted pharmacological therapy can lead to successful reverse remodelling and favourable maternal outcomes.