J Korean Surg Soc 2011;80:S40-42 DOI: 10.4174/jkss.2011.80.Suppl 1.S40 CASE REPORT JKSS Journal of the Korean Surgical Society pISSN 2233-7903ㆍeISSN 2093-0488 Cardiac tamponade caused by tuberculosis pericarditis in renal transplant recipients Jong Man Kim, Sung-Joo Kim, Jae-Won Joh, Choon Hyuck David Kwon, Yong Bin Song1, Milljae Shin, Ju Ik Moon, Gum O Jung, Gyu-Seong Choi, Bok Nyeo Kim2, Suk-Koo Lee Departments of Surgery and 1Internal Medicine, 2Organ Transplant Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea A 50-year-old male, renal transplant recipient, was admitted with fever and chest discomfort. At admission, chest radiologic finding was negative and echocardiography showed minimal pericardial effusion. After 2 days of admission, chest pain worsened and blood pressure fell to 60/40 mmHg. Emergency echocardiography showed a large amount of pericardial effu- sion compressing the entire heart. Pericardiocentesis was performed immediately. Mycobacterium tuberculosis was isolated from pericardial fluid. Tuberculosis pericarditis should be considered as the cause of cardiac tamponade in renal transplant recipients, even with the absence of pericardial effusion in the initial study or suggestive history. Key Words: Pericardiac tamponade, Renal transplantation, Tuberculosis, Tuberculosis pericarditis INTRODUCTION CASE REPORT Mycobacterium tuberculosis infection affects less than 1% of solid organ transplant recipients, but cumulative in- cidence is three times that of the general condition [1,2]. Tuberculosis infection represents an important cause of mortality and morbidity in solid organ transplant recipi- ents [3]. The higher incidence of extrapulmonary tuber- culosis infection in renal transplant recipients can retard diagnosis and treatment with increased morbidity and mortality rates [3,4]. Here we report a case that cardiac tamponade caused by rapidly increasing pericardial effu- sion due to tuberculosis pericarditis. A 50-year-old male was admitted to the hospital with two weeks history of fever and chest discomfort. There was no other complaint. He had deceased donor kidney transplantation one month ago for hypertension and chronic renal failure and was on tacrolimus 2.5 mg bid, methylprednisolone 8 mg bid, and mycophenolate mofetil 500 mg bid. Drug levels of tacrolimus and mycophenolic acid were 5.9 ng/mL (normal range, 5 to 20 ng/mL) and 1.89 mg/L (normal range, 1.0 to 4.0 mg/L). His general con- dition was tolerable and vital signs were blood pressure 118/69 mmHg, heart rate 91/min, respiration rate 20/min, and body temperature 37.1oC. Initial laboratory study Received January 8, 2010, Accepted February 22, 2010 Correspondence to: Sung-Joo Kim Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: ＋82-2-3410-3476, Fax: ＋82-2-3410-0040, E-mail: kmhyj111@hotmail.com cc Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2011, the Korean Surgical Society