A case report of Trichinella spiralis pericarditis: an unusual cause of pericardial effusion and cardiac tamponade in an immunocompetent urban black African

Background Cardiac trichinellosis is unusual and it is associated with high mortality. We report a case of Trichinella pericarditis complicated by a large pericardial effusion and cardiac tamponade in a setting where the aetiologic diagnosis of pericardial disease is challenging. Case summary A 27-year-old immune-competent male patient from Cameroon consulted for pleuritic chest pain associated with fever, dry cough, and gradually worsening dyspnoea on exertion of 1-month duration. Upon admission, his blood pressure was 100/73 mmHg, the heart rate was 130/min. The clinical examination revealed a pericardial friction rub, jugular venous distension, and tender hepatomegaly. There was no lower extremity oedema. The diagnosis of pericarditis was made. A two-dimensional transthoracic echocardiogram performed showed a moderate fibrinous circumferential pericardial effusion with echocardiographic signs of tamponade. Pericardiocentesis was performed and analysis of the fluid revealed multiple, motile, roundworms which were identified as Trichinella spiralis, a nematode parasite. There was no eosinophilia on complete blood count. He was treated with Albendazole 800 mg daily per os. His clinical condition improved with resolution of the symptoms and a reduction in the size of the pericardial effusion. Discussion Trichinella spiralis is a rare cause of pericarditis which can be life-threatening. With the existing challenges in diagnosing the aetiology of pericardial disease in African resource-limited setting, the diagnosis can be missed leading to fatal outcomes.