Diagnostic strategy for tuberculous pericarditis in resource-limited settings

A 58-year-old female farmer from a tuberculosis (TB)-endemic region presented with a 10-day history of fever, dyspnea and dry cough. Examination revealed tachycardia, tachypnea and dull heart sounds. Initial computed tomography (CT) scan (Figure 1A) showed a large pericardial effusion and bilateral pleural effusions. She was initially misdiagnosed with pneumonia and congestive heart failure and received antibiotics and diuretics without improvement. ... Ultrasound-guided pericardiocentesis yielded 800 ml of exudative fluid. Analysis showed elevated adenosine deaminase (ADA) (47 U/l, reference >35 U/l) and a positive T-SPOT.TB (interferon-gamma release assay (IGRA)). Mycobacterium tuberculosis was subsequently cultured from the fluid, confirming tuberculous pericarditis (TBP). The diagnosis was based on: (i) epidemiological context; (ii) clinical presentation with multi-serous effusions; (iii) supportive biomarker profile (elevated ADA, positive IGRA); and (iv) definitive culture. The patient underwent therapeutic pericardiocentesis. Standard antitubercular therapy (HRZE regimen) was promptly initiated. Adjuvant corticosteroids were withheld in line with current evidence.1 She improved symptomatically within 2 weeks. A follow-up CT at 3 months (Figure 1B) showed complete resolution of all effusions.