Granulomatous Pericarditis in a Sudden Death: The Critical Role of Forensic Histopathology in Diagnosing Latent Tuberculosis

Background Disseminated tuberculosis, specifically tuberculous pericarditis, represents a diagnostically challenging yet critical contributor to sudden death. The condition frequently progresses without overt symptoms, evading clinical detection especially among young migrants from endemic regions. Forensic histopathologist is often the first and only person to identify this reportable disease. Without a systematic forensic autopsy including histology, this death would have been certified as "undetermined". The present case emphasizes the necessity of improved TB screening initiatives for high-risk populations, such as recent immigrants from endemic nations. Case presentation A 24-year-old male immigrant of Black ethnicity was received a case of sudden death. The person had been declared deceased upon arrival at the hospital, and resuscitation attempts were unsuccessful. Neither previous clinical history nor reviewable medical data were accessible. The deceased's exterior examination revealed a slim physique, cachexic, with a slumped posture. The autopsy examination showed granulomatous pericarditis and purulent lung abnormalities, but no signs of trauma or toxication. A histopathological analysis of the pericardium showed multinucleated giant cells, lymphocytes, epithelioid cells, and central necrosis—all of which are indicative of tuberculous pericarditis. Additionally, lung tissue examination revealed military TB. The cause of death was determined to be disseminated tuberculosis, which resulted in respiratory and circulatory collapse, even though no premortem symptoms or medical history were recorded. Conclusion This case highlights the indispensable role of systematic autopsy and histopathological examination in identifying occult tuberculosis in medicolegal investigations, especially in high-risk populations. Forensic pathology enhances mortality data quality, enables contact tracing to avoid transmission, and informs targeted screening programs to strengthen TB control in the country.