Early diagnosis in an unusual presentation of tubercular pericarditis-A case report

Patients with tuberculosis sometimes may present with atypical, unusual features. The reported case is of 57 years male admitted with chief complaint of fever and breathlessness. Spiral CT chest revealed significant pericardial effusion all around heart, bilateral pleural effusion and multiple ill defined alveolar nodules scattered in both the lungs, more so in upper lobes. No significant mediastinal lymphadenopathy was seen. Pericardial fluid on Ziehl-Neelsen staining revealed acid fast bacilli. Subsequently sputum examination also showed acid fast bacilli. Hence pericardial fluid examination is helpful in the diagnosis of tubercular pericarditis. Tuberculosis can have protean manifestations as in this case with bilateral pleural effusion, pericardial effusion and mottling of lungs. Therefore clinician needs to keep complex presentation of tuberculosis in mind to manage the case at its earlier stage to avoid residual complications.