Diagnostic strategy for tuberculous pericarditis in resource-limited settings

A 58-year-old woman from a TB-endemic area presented with fever and dyspnea. Imaging revealed large pericardial and bilateral pleural effusions. Initial misdiagnosis as pneumonia and heart failure led to ineffective treatment. Pericardial fluid analysis showed elevated adenosine deaminase (ADA, 47 U/L) and a positive interferon-gamma release assay (IGRA). Mycobacterium tuberculosis was later isolated from the fluid culture. This case illustrates a pragmatic diagnostic triad (ADA, IGRA, culture) for tuberculous pericarditis in settings lacking advanced molecular tools, enabling timely initiation of antitubercular therapy.