Background: Recurrent episodes of isolated pericardial effusion due to tuberculosis,
leading to reduced Left Ventricle Ejection Fraction (LVEF), are uncommon.
Methods: This is a case report of a previously healthy 32-years old male with tuberculous induced
pericardial effusion as isolated manifestation. The only known exposure of tuberculosis was a
brother with whom the patient did not have physical contact during the last year. The pericardial
effusion repeatedly appeared after being drained a total of three times. Due to recurrent episodes of
pericardial effusion, severe thickening of the pericardium, pericardial adherences and increasing
affection on the heart, pericardiectomy was ultimately performed.
Results: Biochemical examination, chest X-ray, computed tomography of thorax and abdomen and
cytology report did not reveal any signs of malignancy, connective tissue disease or other infections
including extra-pulmonary/pulmonary tuberculosis. However, the pericardial biopsy was Polymerase
Chain Reaction positive (PCR) for tuberculosis DNA and showed granulomatous inflammation
with necrosis. After 6 months anti-tuberculous therapy, biochemical parameters, LVEF
and the clinical condition of the patient were normalized.
Conclusion: Tuberculosis can be difficult to diagnose when it only manifests as pericardial effusion
especially if the time for exposure is long before the appearance of symptoms and admission.