Constrictive pericarditis: Detection of mycobacterium tuberculosis in paraffin-embedded pericardial tissues by polymerase chain reaction Mahmood Zamirian a , Mehdi Mokhtarian a , Mohammad Hosein Motazedian b , Ahmad Monabati c , Gholam Reza Rezaian a, ⁎ a Department of Internal Medicine (Cardiology), Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran b Department of Microbiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran Received 8 August 2006; received in revised form 3 December 2006; accepted 27 December 2006 Available online 13 January 2007 Abstract Background: Although the utility of polymerase chain reaction (PCR) for diagnosis of acute pleuro-pericardial tuberculosis has been well established, its use for chronic constrictive pericarditis is yet to be reported. Aims: To define the sensitivity and specificity of PCR for diagnosis of tuberculosis (TB) in patients with constrictive pericarditis. Methods: The medical records of 30 consecutive patients with constrictive pericarditis were reviewed. In addition their historical paraffin- embedded pericardial tissues were used for new histopathologic examination and PCR amplification for Mycobacterium tuberculosis genome. Results: There were 23 males and 7 females with a mean age of 35 ± 19.5 years. The anticipated causes of constriction included idiopathic (n = 21), tuberculosis (n = 5), cardiac surgery (n = 2) and post traumatic (n = 2). PCR became positive in nine patients. Four out of 5 patients with tuberculous granuloma had a positive test result. In addition all 4 patients with non-tuberculous constrictive pericarditis had a negative test result. Therefore considering the presence or absence of granuloma as a diagnostic criteria, the sensitivity and specificity of PCR were 4/5 (80%) and 20/ 25 (80%), respectively. © 2007 Published by The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. Keywords: Constrictive pericarditis; Mycobacterium tuberculosis; Polymerase chain reaction Introduction Tuberculous constrictive pericarditis is often a diagnostic challenge because of its rarity and non-specific clinical manifestations. The need for pericardiectomy and the ineffi- ciency of the conventional diagnostic methods mandate the evaluation of newer tests. Although nucleic acid amplification techniques such as polymerase chain reaction (PCR) have improved the diagnosis of tuberculous pulmonary diseases [1,2], however, its utility for constrictive pericarditis is yet to be examined. Here we report our experience with PCR to diagnose tuberculosis in 30 such patients. Material and methods The medical records of 30 consecutive patients with constrictive pericarditis were reviewed. In addition their paraffin embedded pericardial tissues were obtained from the archives of our pathology department for DNA detection of mycobacterium tuberculosis. The tissue blocks were collected between 1970 and 2004. Histopathologic and PCR assessments were independently done by a pathologist and a microbiologist who were blinded to the patient's initial (admission time) clinical and pericardial histopathologic findings. Patients There were 23 (77%) males and seven (23%) females with an age range of 7 to 74 (35 ± 19.5) years. Constrictive pericarditis Clinical Biochemistry 40 (2007) 355 – 358 ⁎ Corresponding author. E-mail address: grezaian@gmail.com (G. Reza Rezaian). 0009-9120/$ - see front matter © 2007 Published by The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.clinbiochem.2006.12.005