Purulent Pericarditis Leading to Cardiac Tamponade and Constrictive Physiology

BACKGROUND: Purulent pericarditis is a rare infection of the pericardial space, characterized by the accumulation of pus. CASE SUMMARY: A middle-aged woman presented with chest pain. Serial echocardiograms over approximately 16 hours demonstrated the development of cardiac tamponade and obstructive shock. Emergency pericardiocentesis yielded purulent fluid, which grew Streptococcus pneumoniae. Despite hemodynamic improvement, she subsequently developed constrictive physiology (CP), which was diagnosed with cardiac catheterization and cardiac magnetic resonance. DISCUSSION: This case illustrates an uncommon and life-threatening presentation of purulent pericarditis. The patient's rapid progression highlights the importance of early recognition and timely drainage. Additionally, the development of CP emphasizes the need for appropriate diagnostic modalities. TAKE-HOME MESSAGES: Purulent pericarditis is a rare condition that may present without a clear infectious source. It may be complicated by the development of CP, and both cardiac catheterization and cardiac magnetic resonance are important diagnostic tools.