Eur J Pediatr (2008) 167:811–812 DOI 10.1007/s00431-007-0559-z SHORT REPORT A 15-year-old girl with a large pericardial effusion Roel J. Bolt & Lukas A. Rammeloo & A. Marceline van Furth & Gijs T. J van Well Received: 2 May 2007 / Accepted: 19 June 2007 / Published online: 18 August 2007 # Springer-Verlag 2007 Abstract Pericarditis is a rare manifestation of tuberculosis and can be fatal. We describe a 15-year-old girl admitted for a large pericardial effusion. Subxiphoid pericardial biopsy was performed. Biopsy samples were positive for M. tuberculosis DNA by PCR, which confirmed the diagnosis of tuberculous pericarditis. Keywords Tuberculosis . Pericarditis Subxiphoidal biopsy . Corticosteroids A 15-year-old girl was admitted with chest pain, progres- sive shortness of breath, fever, nonproductive cough, decreased appetite, weight loss, and fatigue. The patient R. J. Bolt Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands Present address: R. J. Bolt (*) St. Franciscus Gasthuis, P.O. Box 10900, Rotterdam 3004 BA, The Netherlands e-mail: r.bolt@sfg.nl L. A. Rammeloo Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands e-mail: L.Rammeloo@vumc.nl A. M. van Furth : G. T. J. van Well Department of Pediatric Infectious Diseases, VU University Medical Center, Amsterdam, The Netherlands A. M. van Furth e-mail: AM.vanFurth@vumc.nl G. T. J. van Well e-mail: G.vanWell@vumc.nl was born in Angola, but had lived in the Netherlands for 14 years. Seven months before admission she had traveled to the Democratic Republic of Congo in Western Africa. Her temperature was 39.7°C, her pulse 90 beats/min, respiratory rate 28 breaths/min, and blood pressure 96/ 58 mmHg. No enlarged lymph nodes were found. Soft cardiac tones and a friction rub were noticed. The liver was enlarged. Laboratory results showed normal white blood cells and platelets with a decreased hemoglobin (4.3 mmol/l). The erythrocyte sedimentation rate was 60 mm/h. A chest radiograph showed marked enlargement of the cardiac silhouette with no other abnormalities. Echocardi- ography revealed a large pericardial effusion containing exudative debris and fibrin strands (Fig. 1). Extensive laboratory studies for auto-immune diseases and infections, including HIV, did not reveal the cause. Under general anesthesia the pericardial fluid was drained and a subxiphoid pericardial biopsy was performed. The PCR for M. tuberculosis DNA was positive on the pericardium, though not in the pericardial fluid. The patient was treated with four anti-tuberculous drugs (isoniazide, ethambutol, pyrazinamide, rifampicin) for 4 months and two anti-tuberculous drugs for an additional 4 months. Adjunctive treatment with predinisolone was tapered over a 12-week period. The patient completely recovered and did not develop any signs of constrictive pericarditis. She was followed up for more than 1 year and then discharged because of uneventful recovery. Discussion Pericarditis is a rare manifestation of tuberculosis that can be fatal and accounts for approximately 1–2% of all cases