Abstract
Tuberculous pericarditis is a serious extrapulmonary complication of tuberculosis (TB) that is difficult to diagnose and can lead to cardiac tamponade. This report describes the case of an immunocompetent man who developed cardiac tamponade due to a paradoxical response during TB treatment. No pericardial effusion was observed at the time of diagnosis. However, he developed cardiac tamponade 35 days after the initiation of anti-TB drugs. He was treated with emergency pericardial drainage and systemic corticosteroid therapy, after which his hemodynamic status improved. Although there was no recurrence of the increased pericardial effusion, the patient died from a central venous catheter-related bloodstream infection. Cardiac tamponade caused by a paradoxical response is extremely rare in a patient without human immunodeficiency virus infection. Even if there are no findings of tuberculous pericarditis at the time of diagnosis, the possibility of a paradoxical response should be considered in a patient who subsequently develops cardiac tamponade.