Milky heart: A rare case of tuberculous chylopericardium managed conservatively

IntroductionTuberculosis (TB) is a rare cause of chylopericardium. Optimal management remains unclear.Methods/ResultsA 30-year-old Filipino male presented with recurrent massive pericardial effusions, with pericardiostomy revealing chylopericardium. Microbiologic TB studies were negative, and other etiologies were excluded. Pericardial fluid adenosine deaminase was elevated; anti-TB regimen was initiated, leading to resolution.DiscussionThere is no consensus about the optimal management of TB chylopericardium. Adenosine deaminase represents a useful test to diagnose TB in inflammatory, lymphocyte-predominant effusions, especially when other tests are negative. Failed conservative management merits more invasive approaches.ConclusionWhile data remain lacking, this case suggests that TB chylopericardium responds to anti-TB therapy.