Case Report

Overlap syndrome; the actual cause of a presumed TB pericardial effusion- A case report

Alma Bachlani
Jinnah Medical and Dental College Karachi Pakistan
Ishaq Ghauri
Jinnah Medical and Dental College Karachi Pakistan
Urooj Riaz
Jinnah Medical and Dental College Karachi Pakistan

✉ Correspondence: Alma Bachlani Email: dr.alma_bachlani@outlook.com

DOI https://doi.org/10.70302/jpsim.v7i3.2650
Volume: 7, Issue 3 Pages: 267–269 Published: 21 Aug 2026
Received: 15 Jan 2026 Revised: 30 May 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

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

How to Cite This Article

Bachlani A, Ghauri I, Riaz U. Overlap syndrome; the actual cause of a presumed TB pericardial effusion- A case report. J Pak Soc Intern Med. 2026;7(3):267–269. doi:10.70302/jpsim.v7i3.2650

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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