Tuberculous pericarditis is a rare but dangerous disease with a mortality of 20% to 40%. Early diagnosis and institution of appropriate therapy are critical, and open pericardial biopsy appears to be the most reliable diagnostic tool. Corticosteroids, in conjunction with antituberculous medication, are effective in suppressing the early granulomatous inflammatory response. Pericardiectomy should be considered early when the response to a medical regimen is delayed or inadequate.