Unmasking Tuberculosis: A Case of Pericardial Effusion in a Young Adult With Recurrent Pneumonia

This case presents a 25-year-old Indian male with no significant past medical history presenting to the emergency department (ED) due to two weeks of productive cough with pleuritic chest pain. The patient presented one week earlier to the ED; however, he left against medical advice and was given a 5-day course of Azithromycin 250 mg that minimally improved his symptoms. He returned to the ED shortly after completing the antibiotics and was admitted for further evaluation. He was diagnosed with multifocal pneumonia and started on intravenous antibiotics, then discharged two days later on oral outpatient therapy. One month later, the patient returned to the ED with similar symptoms of worsening productive cough and pleuritic chest pain. CT chest findings revealed a left-sided pleural effusion and large pericardial effusion, which later prompted microbiological testing that confirmed a Mycobacterium tuberculosis infection. A pericardial window was indicated due to tamponade physiology. Although the patient did not present with classic constitutional symptoms of tuberculosis, this case shows the importance of keeping TB high in the differential list among those with recurrent pneumonia and unexplained pleural and pericardial effusions, especially in patients with recent immigration or insidious risk factors, despite how rare pathologies such as pericardial TB can be. Early correct diagnosis and appropriate diagnostic workup, including imaging and microbiological studies, should be ordered to prevent delay in treatment and reduce morbidity.