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Filariasis presenting as pericardial effusion with cardiac tamponade is rare. We report a case of 34-year-old male who presented with a short history of fever, bilateral pedal edema and left sided chest discomfort of 10 days duration. On evaluation he was found to have pericardial effusion. Extensive work up to evaluate routine causes of pericardial effusion was unremarkable. His pericardial fluid showed microfilaria, however there was no microfilariae in peripheral blood smear. He was managed with pericardiocentesis and 04 weeks of Albendazole, diethylcarbamazine to which he responded. In the tropics filarial pericardial effusion should always be considered in cases of pericardial effusion of unknown etiology.
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