Overlap Syndrome; The Actual Cause of a Presumed TB Pericardial Effusion- A Case Report

Authors

Abstract

Pericardial effusion is a common manifestation of tuberculosis in endemic regions; however, autoimmune disorders should also be considered in the differential diagnosis. A 23-year-old woman initially presented with severe pericardial effusion and early cardiac tamponade. Despite negative microbiological investigations for tuberculosis, mildly elevated pericardial fluid adenosine deaminase (ADA) levels led to a presumptive diagnosis of tuberculous pericarditis and initiation of anti-tuberculosis therapy. She later developed ATT-induced hepatitis with persistent constitutional symptoms, polyarthritis, serositis, and proteinuria. Further autoimmune evaluation revealed strongly positive ANA, anti-RNP, anti-dsDNA, and other autoantibodies with low complement levels, confirming overlap syndrome (mixed connective tissue disease). Following corticosteroids and azathioprine, the patient demonstrated marked clinical and laboratory improvement. This case highlights the diagnostic challenge of distinguishing tuberculous pericarditis from autoimmune serositis in TB-endemic settings. A comprehensive evaluation is essential when microbiological evidence is lacking or patients fail to respond to empirical anti-tuberculosis therapy.

Keywords:

Overlap syndrome, Mixed connective tissue disease, Pericardial effusion, Tuberculous pericarditis

Published

2026/08/22

Issue

Vol. Volume 7-issue 3

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