Background: Tuberculosis is common in developing countries such as in the Philippines but may initially present with nonspecific signs and symptoms which may be catastrophic if misdiagnosed or left untreated.
Case: We report a case of a 30-year old female complaining of non-productive cough of 1 month duration followed by onset of progressive exertional dyspnea and significant weight loss within 3 months. Two dimensional echocardiography revealed pericardial effusion and thickened pericardium with note of homogenous densities in the pericardial space superior to the right and left atria, and posterior to the left atrium and ventricle. Cardiac MRI revealed diffuse thickening and enhancement of the pericardium and nodular myocardial thickening within the right and left atrial walls. Contrast CT scan of the chest showed tiny subcentimeter nodules scattered in both lungs with associated enlarged calcified and non-calcified lymph nodes in both axillary, prevascular, paratracheal and right hilar regions. Biopsy of the axillary lymphnode was done and revealed caseous necrosis. Patient was then started on anti-Koch's medications and was discharged, improved.
Conclusion: Tuberculous myopericarditis is a rare form of extrapulmonary tuberculosis and requires a high index of suspicion for timely diagnosis. In a country wherein tuberculosis is endemic, tuberculosis should always be a consideration in cases of myopericarditis with no apparent cause. Early recognition and initiation of anti-tuberculosis treatment could not be overemphasized since this condition may prove fatal if left untreated.