Disseminated Tuberculosis With Granulomatous Pericarditis: The Essential Role of Forensic Histopathology in a Case of Unexpected Death

Disseminated tuberculosis, specifically tuberculous pericarditis, represents a diagnostically challenging yet critical contributor to unexpected death in forensic practice, particularly among young migrants from endemic regions who lack access to healthcare. Forensic histopathology is often the first and only means to identify this reportable disease. Without a systematic forensic autopsy including histology, this death would have been certified as "undetermined". The present case emphasizes the necessity of improved TB screening initiatives for high-risk populations such as recent immigrants from endemic nations. We present the case of a 24-year-old male immigrant of Black ethnicity who was referred for forensic autopsy after an unexpected death. The individual was pronounced dead upon arrival at the hospital. No previous clinical history or antemortem medical data were available. External examination revealed a slim, cachectic physique with a slumped posture. Autopsy examination showed granulomatous pericarditis and extensive purulent lung abnormalities, with no signs of trauma or toxication. Histopathological analysis of the pericardium showed multinucleated giant cells, lymphocytes, epithelioid cells, and central necrosis, all of which are indicative of tuberculous pericarditis. Additionally, lung tissue examination revealed disseminated tuberculous involvement with granulomatous inflammation. The cause of death was determined to be disseminated tuberculosis, which resulted in respiratory and circulatory collapse, despite the absence of documented premortem symptoms or medical history. This case highlights the indispensable role of systematic autopsy and histopathological examination in identifying undiagnosed tuberculosis in medicolegal investigations, especially in high-risk populations. Forensic pathology enhances mortality data quality, enables contact tracing to prevent transmission, and informs targeted screening programs to strengthen TB control.