figure 3B. Repeated transthoracic echocardiogram TTE four
chamber view revealing no pericardial effusion one day after
pericardiocentisis
Laboratory testing at the time revealed normal white blood cell count,
haemoglobin, and platelets count of 7.0 × 111/L, 125 g/L, and 288 ×
109/L, respectively. The patient’s electrolytes and renal function were
also normal (sodium 144 mmol/L, potassium 3.8 mmol/L, and creatinine 77
μmol/L)
A comprehensive analysis of pericardial fluid, encompassing cytology,
culture, biochemistry, and ADA levels, was conducted to rule out
atypical tuberculosis. Imaging studies, including chest X-ray and chest
CT were inconclusive. Given the high prevalence and ambiguity of
tuberculosis in Iraq, screening, including AFB swap and Gene Xpert,
yielded negative results. Despite this, a trial of anti-tuberculosis
therapy was initiated for two months with regular biweekly follow-ups.
Serial echocardiograms showed no significant pericardial effusion, yet
recurrent symptoms, such as high-grade fever, back pain, and exertional
dyspnoea, persisted.