Introduction: Extrapulmonary tuberculosis (EPTB) adds to India’s significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. Presentation: This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. Conclusion: This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.

Background Thrombotic complications remain an important concern after transcatheter aortic valve replacement (TAVR), particularly because leaflet thrombosis may impair prosthetic valve function and contribute to adverse clinical outcomes. Patients with pre-existing hypercoagulable disorders may represent a higher-risk subgroup, yet their outcomes after TAVR have not been well characterized. We evaluated whether selected hypercoagulable conditions were associated with worse inpatient outcomes following TAVR. Methods The National Inpatient Sample was queried from 2018 through 2020 to identify adult hospitalizations involving TAVR. Hypercoagulable status was defined by the presence of systemic lupus erythematosus, antiphospholipid antibody syndrome, Factor V Leiden mutation, lupus anticoagulant syndrome, or prothrombin gene mutation using ICD-10-CM codes. Among 205,565 TAVR hospitalizations, 1,480 involved patients with one or more of these conditions. Baseline characteristics were compared using Mann-Whitney U and Chi-square testing. Multivariable logistic regression was then used to assess the relationship between hypercoagulable status and inpatient clinical outcomes, with statistical significance defined as p < 0.05. Results The study cohort had a median age of 80 years (IQR 73–85), and 43.9% were female. After adjustment, the presence of a hypercoagulable condition was not independently associated with a statistically significant increase in any primary or secondary inpatient outcome. However, several clinically relevant trends were observed. Patients with hypercoagulable states had numerically higher odds of all-cause mortality (OR 1.68) and major adverse cardiovascular events (OR 1.36). They also demonstrated higher odds of prosthetic valve leakage (aOR 1.14) and prosthetic valve thrombosis (aOR 5.03), although these associations did not reach statistical significance. Conversely, post-procedural pacemaker implantation (OR 0.86) and cerebrovascular accident (OR 0.72) were numerically less frequent in the hypercoagulable group. Conclusion In a national cohort of patients undergoing TAVR, underlying hypercoagulable disorders were not significantly associated with worse adjusted inpatient outcomes. Nevertheless, the direction of effect for mortality, MACE, prosthetic valve leakage, and particularly prosthetic valve thrombosis suggests a possible signal toward increased thrombotic and adverse cardiovascular risk. These findings highlight the need for larger studies with more granular clinical and antithrombotic data to better define post-TAVR risk and management strategies in patients with hypercoagulable conditions.