04 December 2017 to 07 December 2017	A 51-year-old woman presented with dyspnoea, face, and limb swelling.
	Transthoracic echocardiography (TTE) showed moderate pericardial effusion.
	Blood test did not show specific disease pattern.
	Immunoglobulins, immunofixation—negative.
08 December 2017	Discharged home with out-patient follow-up in a week with repeat TTE.
13 December 2017 to 15 December 2017	Review in acute admission unit. Progressive symptoms, worsening of pleural effusions on chest x-ray. Admitted to hospital for further management.
	Viral serology and TB screen negative.
	Repeat TTE showed large pericardial effusion with haemodynamic compromise. Drained 800 mL of exudate.
19 December 2017	Computed tomography chest/abdomen/pelvis—no evidence of malignancy.
	Discharged home as she was haemodynamically stable.
29 December 2017 to 17 January 2018	Second admission with dyspnoea.
	Transthoracic echocardiography confirmed large pericardial effusion with 500 mL of exudate drained.
	Compliment level and carcinoembryonic antigen levels normal.
	Pleural tap also confirms exudate.
	Angiotensin-converting enzyme levels, amyloid screen negative.
	Bone marrow biopsy and tap normal.
	No infiltrative or infective diseases on cardiac magnetic resonance imaging.
	Discharged home on oral steroids.
18 June 2018	Cardiology follow-up with repeat TTE.
	Clinical improvement in symptoms and swelling.
15 August 2018	Review by immunologist in specialist centre, diagnosis of capillary leak syndrome.
	Advised pulsed immunoglobulins for relapse.
02 November 2018	Started on anti-tumour necrosis factor (TNF).
23 April 2019	Off steroids, on anti-TNF therapy Etanercept, TTE showed reduction in pericardial fluid (posterior wall 1 cm, right ventricular free wall 1.1 cm).
28 June 2019	On weekly Etanercept therapies, there is minimal pericardial effusion and no relapse of generalized oedema.