Cardiac Tamponade Due to Entamoeba histolytica in a Patient in a Nonendemic Region

Entamoeba histolytica infection is classically associated with intestinal disease and liver abscesses in endemic regions. Pericardial involvement with cardiac tamponade is an exceptionally rare, life-threatening complication. We present a case of a 58-year-old man in the United States with no recent travel who developed pericardial tamponade due to diaphragmatic communication with an E histolytica liver abscess. His case underscores the need to consider parasitic infections in the differential diagnosis of purulent pericardial effusions, even in nonendemic areas, and demonstrates how serologic testing and multidisciplinary collaboration were critical for diagnosis and management of this unexpected condition.