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.