Tuberculous pericarditis and HIV

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Tuberculous pericarditis and HIV. Wellcome Collection. Attribution 4.0 International (CC BY 4.0). Source: Wellcome Collection.

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This is a chest x-ray of a young, HIV-positive woman who presented with breathlessness. It shows a markedly enlarged cardiac silhouette. Note that the lung fields are clear. Echocardiography confirmed a large pericardial effusion. The pericardial aspirate showed a fibrinous exudate, but Ziehl-Neelsen (ZN) staining of this sample was negative for acid-fast bacilli (AFBs). The patient made a good clinical response to antituberculous therapy in conjunction with oral prednisolone.

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