Two quite dyspneic HIV positive patients were admitted to the Emergency Room; they presented with aspects and images suggesting pericardial effusion. The analysis of an initial liquid puncture did not show any specificity and the patients did not register any clinical improvement. Both patients were submitted to a subxiphoid pericardial window, all the effusion liquid was drained, and a biopsy of the pericardium tissue was completed revealing a granulomatous process. Good evolution was the result of specific treatment. Such findings draw attention to a high possibility of pericardial suffusion in AIDS patients being tuberculosis, in particular if one considers the high prevalence of this disease in Brazil. The results also showed that the opening of a subxiphoid pericardial window and the specific triple scheme is a procedure that leads to good therapeutic evolution in this kind of patients.