In this report we describe the case of a 22-year-old female who presented to our hospital with a 2 week history of chest tightness and easy fatigability. Examination and chest ultrasound revealed a massive pericardial effusion with evidence of tamponade. A rapid test for HIV was positive. Diagnostic and therapeutic pericardiocentesis was performed with good clinical response and revealed serosanguinous, exudative fluid. According to national guidelines, the patient was empirically treated for tuberculous pericarditis. Recurrence of the pericardial effusion occurred after 2 weeks and the cardiothoracic surgeons were consulted. Several days later, the patient was taken to the operating theatre and a pericardial window was performed with resultant drainage of over 5 litres of pericardial fluid. Visualization of the pericardium revealed a purple, multinodular mass of about 4x6cm on the epicardium consistent with Kaposi’s sarcoma of the pericardium. Five litres of blood stained fluid were drained. Anti-tuberculosis treatment was stopped and the patient was referred to the oncology unit. The patient was started on antiretroviral treatment and Vincristine chemotherapy and the pericardial effusion resolved completely after 6 cycles of chemotherapy. Kaposi sarcoma should be considered as differential diagnosis in HIV/AIDS patient presenting with massive pericardial effusion.