An uncommon tuberculous journey: from pyothorax to pericardial effusion

Abstract Background Despite advances in antibiotic therapy, bacterial pericarditis leading to pericardial effusion and cardiac tamponade remains a serious concern. Pyopericardium may arise from pneumonia, empyema, thoracic surgery, or hematogenous sepsis. The simultaneous occurrence of pyopericardium and pyothorax is exceptionally rare in an otherwise healthy individual. Case presentation This report presents a case of a 40-year-old immunocompetent male diagnosed with pyopneumothorax and pyopericardium. Due to poor response to broad-spectrum antibiotics, a tuberculous etiology was suspected. Upon initiation of anti-tubercular therapy (ATT), the patient’s condition improved, and Mycobacterium tuberculosis was subsequently confirmed via culture. Conclusion The coexistence of pyothorax and purulent pericarditis in an immunocompetent individual necessitates urgent intervention. Given tuberculosis endemicity in India, such cases should prompt early suspicion of tuberculous pathology.