A Typical Presentation of Tuberculous Pericarditis: Case Report

A 23-year-old woman was admitted to the hospital for the management of progressive shortness of breath, fever and pleural effusion. Initial work up was negative for bacterial infection, tuberculosis and HIV. Further work up with echocardiographic study during admission revealed a moderate pericardial effusion (~4 cm in thickness) but with no tamponade effect. Pericardiocentesis was performed and 1.2 L of sero-sanginous fluid was drained. All tumour and autoimmune markers were unremarkable. Rapid acid-fast bacilli culture demonstrated the growth of Mycobacterium tuberculosis. She was started on anti-TB medications and tolerated them well. Follow-up echocardiographic study and chest X-ray showed no re-accumulation of pericardial or pleural fluid. Tuberculous pericarditis is rare in developed countries but may still be seen in immigrant population. The variable clinical presentation make early diagnosis challenging and require high index of suspension.