A 34-year-old man from Sao Tome and Principe, Africa, with a history of tuberculosis and alcohol ingestion greater than 100 g/day presented with progressively worsening dyspnoea, right upper quadrant pain and progressively increasing abdominal volume. Physical examination revealed distended jugular veins, tender hepatomegaly, moderate ascites and oedema of lower limbs. MRI revealed collection of pericardial fluid compressing the right ventricle and a thickened pericardium, consistent with an effusive-constrictive pericarditis. Cultures and biopsies were undertaken. Antituberculosis drugs and prednisolone were initiated and drainage of the pericardial collection and pericardiectomy were performed. He recovered with complete remission of signs and symptoms.