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Tuberculous Pericarditis — EECC MCQ

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ModeratePericardial DiseaseTuberculous PericarditisEECC

A 35-year-old man from Sub-Saharan Africa presents with a large haemorrhagic pericardial effusion, constitutional symptoms, and weight loss. Pericardial fluid analysis shows a lymphocytic exudate with elevated adenosine deaminase (ADA) at 55 U/L. What is the most likely diagnosis and recommended treatment?

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Correct answer: D — Tuberculous pericarditis; start quadruple anti-tuberculous therapy (rifampicin, isoniazid, pyrazinamide, ethambutol) for 6 months

In patients from TB-endemic regions presenting with a haemorrhagic, lymphocyte-predominant pericardial effusion and elevated adenosine deaminase (ADA >40 U/L), tuberculous pericarditis is the most likely diagnosis. The 2025 ESC Guidelines recommend ADA measurement as a useful diagnostic marker for TB pericarditis. Treatment is standard quadruple anti-TB therapy for a minimum of 6 months. The role of adjunctive corticosteroids is controversial; the IMPI trial showed that prednisolone reduced constrictive pericarditis in HIV-negative patients but increased HIV-associated cancers. Pericardial biopsy may be required if the diagnosis is uncertain. Long-term follow-up is essential to detect development of constrictive pericarditis.

Reference: ESC (2025): Guidelines for the Management of Myocarditis and Pericarditis