A Wolf in Tuberculosis’ Clothing: Pericardial Mesothelioma Masquerading as Tuberculous Pericarditis

ABSTRACT
Introduction: Primary pericardial mesothelioma is one of the rarest cardiac tumors and carries a poor prognosis. The presence of multiple potential causes of pericarditis can delay diagnosis and initiation of appropriate treatment. Advanced cardiac imaging plays a key role in improving diagnostic accuracy. However, even when a definitive diagnosis is established, therapeutic strategies remain insufficiently standardized and outcomes are often suboptimal. Case presentation: We describe a case of sarcomatoid-type primary pericardial mesothelioma initially misdiagnosed as tuberculous pericarditis. Diagnostic evaluation included multimodality imaging, such as echocardiography, computed tomography, and cardiac magnetic resonance imaging. The patient was subsequently treated with carboplatin and pemetrexed chemotherapy. Despite therapy, the disease progressed, and the patient did not survive. Conclusions: Primary pericardial mesothelioma is a rare and aggressive malignancy typically diagnosed at an advanced stage, contributing to its unfavorable prognosis. Although advanced imaging modalities aid in detection and characterization, standardized diagnostic and therapeutic protocols are urgently needed to enable earlier recognition and more effective management.