The exudative-constrictive tuberculosis pericarditis diagnosed by toracoscopic biopsy

•Tuberculosis is one of the real causes of pericarditis with massive effusion and constriction.•The absence of an active pulmonary process do not exclude the diagnosis.•The negative results of all laboratory tests for tuberculosis do not exclude the diagnosis.•In any cases, it is necessary to use invasive morphological diagnosis, incl. thoracoscopic biopsy.•Pericardiectomy may be required despite complex tuberculostatic and steroid therapy. To present the problems and possibilities of diagnostic and treatment in a patient with resistant exudative-constrictive pericarditis. The male patient 31 y. was admitted to the clinic due to exudative pericarditis and arthritis of the left knee joint. His medical history periodic febrile fever with a cough, episodes of syncope and atrial fibrillation, treatment with antibiotics and corticosteroids with a temporary effect. No data were received for systemic disease, hypothyroidism, tumors. With CT in both lungs, small areas of fibrosis and lymphadenopathy were identified. Pericardial sheets diffusely thickened. EchoCG shows one liter of pericardial fluid with fibrin. All tests for viruses and tuberculosis are negative. Thoracoscopy was performed. Morphological examination showed tuberculosis granulomas with caseous necrosis. The growth of mycobacteria of tuberculosis from sputum was obtained. Therapy included pyrazinamide, ethambutol, levofloxacin, prednisolone 20 mg / day. Ponce's disease regressed. Due to the increase of constriction, subtotal pericardectomy was performed. Tuberculosis is one of the real causes of pericarditis with massive effusion and an outcome in constriction. The negative results of all laboratory tests for tuberculosis do not exclude the diagnosis. It is necessary to use invasive morphological diagnosis, including thoracoscopic biopsy.