Tuberculosis Effusive-Constrictive Pericarditis

Background Effusive-constrictive pericarditis is a rare pericardial syndrome characterized by the coexistence of constrictive physiology and pericardial effusion. Tuberculosis remains a leading cause of pericardial disease in endemic regions, posing significant diagnostic challenges. Case summary A 67-year-old man from Brazil presented with progressive dyspnea, low-grade fever, and signs of right-sided heart failure. Imaging demonstrated constrictive physiology and progressive pericardial calcification. He developed cardiac tamponade requiring surgical pericardiectomy. Analysis of the pericardial fluid revealed a purulent effusion with elevated adenosine deaminase levels (200 U/L), consistent with tuberculous etiology. Despite medical and surgical management, the patient deteriorated owing to refractory shock. Discussion This case illustrates the complex interplay between effusion and pericardial constriction and underscores the diagnostic utility of imaging and biochemical markers such as adenosine deaminase in tuberculosis-endemic settings. Take-home messages Tuberculosis remains a leading cause of effusive-constrictive pericarditis in endemic regions. Early recognition is critical to guide timely and appropriate therapy.