Purulent Pericarditis Complicated With Cardiac Tamponade, Multiorgan Failure, and Constrictive Pericarditis

Background: Purulent pericarditis is a rare but life-threatening condition, with mortality up to 40% despite adequate antibiotics. Case Summary: A 44-year-old previously healthy man with dyspnea and sharp chest pain was diagnosed with purulent pericarditis, which deteriorated rapidly with cardiac tamponade and obstructive shock, requiring emergency pericardiocentesis. After a brief period of stability, another tamponade episode led to multiorgan failure, repeat pericardiocentesis, and intensive care unit admission. Pericardial fluid cultures grew Streptococcus pneumoniae. Multimodality imaging analysis revealed constrictive pericarditis, and the patient underwent surgical pericardiectomy. He was discharged on day 69, with no readmissions at the 1-year follow-up. Discussion: This case illustrates a rare and complex case of purulent pericarditis complicated by cardiac tamponade, multiorgan failure, and constrictive pericarditis. The patient survived owing to prompt diagnosis, source control, repeat pericardiocentesis, and surgical pericardiectomy. Take-Home Message: Purulent pericarditis may be complicated by cardiac tamponade and constrictive pericarditis, which may require surgical pericardiectomy.