Pericarditis and myocarditis are frequent in patients infected with human immunodeficiency virus (HIV), but most cases are asymptomatic or masked by signs and symptoms of other organ system disease. We present a case of cardiac tamponade, secondary to a disseminated tuberculosis infection, in a patient with HIV infection. In HIV-infected patients with symptomatic pericardial effusion, about two thirds have an identifiable cause. A review of the literature emphasises the role of pericardiocentesis in the management of these patients.