[A case of cardiac tamponade caused by tuberculous pericarditis]

An 86-year-old male was admitted to Izumikawa Hospital complaining of fever and chest pain. Electrocardiography revealed low-voltage, atrial fibrillation and QRS complexes. The chest PA-view showed an increased cardiothoracic ratio (65.9%) and an infiltrative shadow in the left lower lung field. Computed tomography revealed copious pericardial and bilateral pleural effusion. Pericardiocentesis was performed immediately after admission, and 80 ml of hemorrhagic fluid was aspirated. The adenosine deaminase activity of the pericardial fluid was 77.2 IU/l, and testing for tuberculous bacilli by polymerase chain reaction was positive. As these parameters strongly suggested tuberculous pericarditis, pericardial drainage was continued for another two weeks, and a delayed combination therapy with isoniazid, rifampicin, streptomycin, and a high dose of prednisolone was initiated. Two weeks later, the symptoms were relieved and the pericardial effusion had also decreased.