Although bloody pericardial effusion often suggests neoplasia, such an event is not rare in tuberculosis (TB), especially in those countries with a high tuberculosis disease burden. Meanwhile, tuberculosis accounts for 50% and greater than 90% of large pericardial effusions in human immunodeficiency virus (HIV)-negative and HIV-positive patients, respectively. Here we report a case of a 24-year-old HIV-negative male who presented with fever and hemorrhagic pericardial effusion. The patient was given presumptive anti-TB treatment before diagnosis was established. Eventually the patient responded well to the anti-TB treatment at the last follow up and the diagnosis was confirmed by aspirated pericardial fluid culture on Lowenstein-Jensen (LJ) medium.