Tuberculosis as the cause of recurrent pericardial effusion: a case report

<p><strong>Background:</strong> Pericardial effusion (PE), affecting approximately 3% of the Western population, has diverse aetiologies including heart failure, malignancy, autoinflammatory, metabolic, or microbiological diseases, and can be induced by trauma or drugs. Guidelines suggest early tuberculosis (TB) testing in patients with PE. However, clinicians in Western Europe often overlook this diagnosis. Therefore, the aim of this report is to emphasize the importance of considering this diagnosis.</p> <p><strong>Case Presentation:</strong> A 72-year-old woman, with a history of aortic valve replacement, was referred for episodes of PE without diagnosis, severe tricuspid insufficiency, and an atrial flutter. PE resisted high-dose anti-inflammatory treatment for sterile pericarditis after ruling out cardiac, banal bacterial, malignant, and autoimmune causes. She underwent surgical tricuspid valve repair with isthmus ablation, and bilateral pericardiopleural windows were created. TB was confirmed via QuantiFERON test and polymerase chain reaction of the pericardial fluid obtained during surgery. Antibiotic and corticosteroid treatment for TB was started with outpatient monitoring. The symptoms decreased after the final antibiotic and corticosteroid therapy.</p> <p><strong>Conclusion:</strong> This case report emphasizes the importance of considering TB as a potential cause of unexplained, recurrent PE in an immunocompetent patient from a non-endemic area, as stated in the guidelines. Especially in an increasingly intercontinental world. Early testing can expedite the start of treatment, reducing complications, invasive procedures, and improving outcomes.</p>