On admission to the tertiary centre, he had evidence of pulsus paradoxus, raised jugular venous pressure, and muffled heart sounds, but no murmurs. Subsequently, he underwent pericardiocentesis, which drained 600 ml of turbid straw-coloured fluid with immediate improvement in the haemodynamic status.
Figure 1. Computed tomography (CT) scan showing pericardial thickening and bilateral pleural effusions
The patient was commenced on regular colchicine and ibuprofen. The initial blood tests showed raised inflammatory markers. The biochemical, microbiological and histopathological analysis of the pericardial fluid was normal, including viral serol