A Case of Fibrinous Pericardial Effusion: Tuberculosis Versus Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with varied presentations, ranging from nonspecific features like fever, malaise, and arthralgia to serious manifestations like serositis (pleural, pericardial effusions), neurological manifestations, and renal involvement (lupus nephritis). SLE is a great mimicker, especially for infections like tuberculosis (TB) which is rampant in low- and middle-income countries (LMIC). We report a case of massive pericardial effusion, which was initially diagnosed and treated as TB on clinico-radiological basis. The patient showed initial clinical improvement. But as the steroids were tapered and stopped, she developed new findings like joint pains, proteinuria, cytopenias, etc leading to reconsideration of diagnosis, which was later revised to SLE based on clinical and laboratory findings. This is one of the uncommon presentations of SLE, leading to misdiagnosis of tuberculosis especially in LMIC.