Abstract
INTRODUCTION: Constrictive pericarditis is a rare and serious complication of pericardial diseases, typically associated with inflammatory or infectious causes. Cryptococcus neoformans involvement is exceptional outside the context of HIV but may occur in immunosuppressed patients. CASE DESCRIPTION: We present a 72-year-old woman with rheumatoid arthritis on chronic corticosteroids who developed progressive dyspnoea, ascites and peripheral oedema. Imaging suggested constrictive pericarditis and pericardiectomy revealed C. neoformans infection. She received antifungal therapy (liposomal amphotericin B plus flucytosine, followed by fluconazole) with a favourable 12-month outcome. DISCUSSION: This case illustrates the importance of considering fungal aetiologies in immunosuppressed patients with pericardial disease. Pericardiectomy was both diagnostic and therapeutic. Antifungal therapy according to international guidelines ensured clinical success. CONCLUSION: Cryptococcal pericarditis, though rare, should be considered in immunosuppressed patients with pericardial effusion or thickening. A combined approach with surgery and antifungals is essential. LEARNING POINTS: Cryptococcal pericarditis is rare but should be suspected in immunosuppressed patients with pericardial effusion or thickening.Pericardiectomy is crucial as both a diagnostic and therapeutic intervention in constrictive pericarditis.Sequential antifungal treatment, in accordance with international guidelines, leads to favourable outcomes.