A 27-year-old male patient from Cameroon presented with precordial pleuritic chest pain of 1-month duration. The pain was associated with intermittent dry cough, low-grade fever, weight loss, and gradually worsening dyspnoea on exertion. The worsening of dyspnoea with the occurrence of paroxysmal nocturnal dyspnoea prompted consultation. He had significant medical history. He was a former inmate who had spent 10 months in prison. The symptoms started while he was in prison. The blood pressure was 100/76 mmHg and the heart rate of 130/min. The heart sounds were regular, rapid, and muffled. There was pericardial friction rub best heard along the left sternal edge. There was jugular venous distension and tender hepatomegaly. There was no lower extremity oedema. The lung examination was normal. The diagnosis of pericarditis complicated with effusion and right heart failure was made. A chest x-ray showed marked symmetric cardiomegaly (Figure 1). The lung parenchyma was normal. The electrocardiogram (ECG) showed sinus tachycardia with a complete left bundle branch block. The White cell count was 8500/mm3, haemoglobin at 9.8 g/dL, mean corpuscular volume (MCV) = 67 fl. The C-reactive protein (CRP) was 48 mg/L and the erythrocyte sedimentation rate (ESR) was 100 mm. The HIV serology was negative. A transthoracic echocardiogram showed a circumferential pericardial effusion measuring 21 mm over the inferior wall and 19 mm over the anterior wall, with a lot of fibrin. There was marked respiratory variation in mitral and tricuspid inflow. There was collapse of the right ventricular free wall. The inferior vena cava (IVC) was dilated with an absent respiratory variation. The left ventricular systolic function was normal. The diagnosis of a large fibrinous pericardial effusion with signs of hemodynamic compromise was made (Figure 2). There was no impairment of global or segmental left ventricular systolic function. He was started on empirical treatment for pericardial TB. An emergency pericardiocentesis was performed draining about 150 cc of straw-coloured fluid which was sent to the laboratory for analysis. A simple wet mount preparation of the fluid revealed motile (coiling) round worms (with slender anterior ends) identified as T. spiralis (Figure 3). An additional movie file shows this in more detail (see Additional files S2 and S3). Total protein of the pericardial fluid was 75.6 g/L which was compartible with an exudate. The anti-TB medications were stopped and the patient was started on albendazole 400 mg twice a day in association with corticosteroids. His clinical condition improved after 5 days with the improvement of dyspnoea and blood pressure. A repeat echocardiogram showed a significant regression of the effusion after 10 days of treatment. The patient was discharged but he never showed up for a follow-up visit.