A Case of Tuberculous Pericardial Effusion with Concurrent SARS-CoV-2 Infection in an Undernourished Child.

abstractTuberculosis (TB) continues to be a major cause of morbidity and mortality in children, especially in the endemic regions. Tuberculous pericardial effusion is a rare but severe extrapulmonary manifestation and may be further complicated by concurrent viral infections such as SARS-CoV-2. To describe a rare case of tuberculous pericardial effusion with concurrent SARS-CoV-2 infection in an undernourished child and to discuss the diagnostic challenges and clinical management. A single-center, descriptive case report from a tertiary care hospital. A 9-year-old underweight, malnourished, unvaccinated male child presenting with acute respiratory distress was evaluated clinically and with imaging. Pericardial fluid analysis, Mantoux test, Cartridge-based Nucleic Acid Amplification Test (CBNAAT), and SARS-CoV-2 RT-PCR were performed. Therapeutic pericardiocentesis and anti-tubercular treatment were administered. Investigations revealed a large pericardial effusion with early tamponade physiology. Pericardial fluid showed a lymphocytic exudate with elevated adenosine deaminase. Mantoux test was positive, supporting a diagnosis of tubercular pericarditis despite negative CBNAAT. Concurrent SARS-CoV-2 infection was confirmed on RT-PCR. The child improved significantly following pericardiocentesis, anti-tubercular therapy, corticosteroids, and supportive management, with excellent recovery at 1-month follow-up. Tuberculous pericardial effusion remains a diagnostic challenge in pediatric patients, especially when co-infected with SARS-CoV-2. A high clinical suspicion is essential in TB endemic regions. Early diagnosis and timely intervention can lead to favorable outcomes even in undernourished and unvaccinated children.