# Acute Large Pericardial Effusion With Haemodynamic Compromise Secondary to Undiagnosed Tuberculosis

## TL;DR

A young man with undiagnosed tuberculosis developed a severe heart condition requiring emergency treatment.

## Contribution

Highlights the importance of considering tuberculosis as a cause of pericardial effusion in appropriate clinical settings.

## Key findings

- A 24-year-old male presented with acute pericardial effusion and hemodynamic compromise due to undiagnosed tuberculosis.
- Anti-tuberculous therapy successfully resolved recurring pericardial fluid accumulation.
- Emergency pericardiocentesis was performed after a positive interferon-gamma assay for tuberculosis.

## Abstract

Tuberculous pericardial effusion is uncommon in the developed countries. However, it remains one of the main causes of presentation with a pericardial presentation with pericardial effusion in the developing world. We present the case of a 24-year-old male patient who presented with a weekly history of diarrhoea, vomiting, shortness of breath and feeling hot. Chest computed tomography revealed a large pericardial effusion with significant haemodynamic compromise. The patient underwent emergency pericardiocentesis, and the pericardial fluid interferon-gamma assay result was positive for tuberculosis. He was unable to tolerate endobronchial biopsy under ultrasound despite heavy sedation and was commenced on anti-tuberculous therapy following a discussion in a multidisciplinary team meeting. He was started on four standard anti-tuberculosis medications, including rifampicin, isoniazid, pyrazinamide, ethambutol and prednisolone. The patient had re-accumulation of pericardial fluid on repeat echocardiography in the first few weeks, which eventually resolved with anti-tuberculous therapy.