Decompensated Liver Disease: An Unusual Manifestation of Constrictive Pericarditis in a Young Child

Abstract

Constrictive pericarditis is a rare but potentially reversible cause of cardiac cirrhosis in children. It results from a thickened and fibrotic pericardium restricting diastolic filling, leading to systemic venous congestion and secondary hepatic fibrosis. Paediatric cases are exceedingly uncommon and often misdiagnosed as primary hepatic disease due to overlapping clinical features. We report a 10-year-old female who presented with progressive abdominal distension and ascites for 25 days, with a history of intermittent abdominal distension and low-grade fever over four years. Examination revealed raised jugular venous pressure, hepatomegaly, and ascites. Investigations demonstrated hepatic fibrosis pericardial thickening with effusion on CECT thorax, and echocardiographic features consistent with effusive–constrictive pericarditis. The tuberculin skin test was strongly positive, although CBNAAT was negative. A diagnosis of probable tubercular constrictive pericarditis with secondary cardiac cirrhosis was made. The child showed significant clinical improvement with anti-tubercular therapy, corticosteroids, and diuretics. Chronic hepatic venous congestion from Constrictive pericarditis can lead to congestive hepatopathy and subsequent cirrhosis. The hepatic dysfunction is often reversible following timely pericardiectomy. However, delayed diagnosis, as in this case, may result in advanced hepatic fibrosis. This case highlights the importance of including Constrictive pericarditis in the differentials of unexplained decompensated liver disease in children, especially in tuberculosis-endemic regions. Early recognition and comprehensive cardiovascular evaluation are essential in paediatric patients presenting with hepatic dysfunction, as prompt intervention can reverse cardiac cirrhosis and prevent irreversible hepatic injury.