Pyopericardium Complicated by Cardiac Tamponade: A Near-fatal Presentation

REPORTcoronavirus disease 2019 infection.He was nonalcoholic, nonsmoker, and denied drug addiction.His complete blood count showed a total leukocyte count of 35400 cells/cumm with 90% neutrophils and 10% lymphocytes.His other biochemical investigations on admission revealed deranged renal functions, raised cardiac enzymes, high C-reactive protein, high procalcitonin, and normal electrolytes, which were indicative of the underlying hidden focus of infection in the body.An electrocardiogram (ECG) showed low voltage complexes and sinus tachycardia with ST-T changes, whereas a chest X-ray (CXR) showed cardiomegaly.Eyeballing of the heart on echocardiography showed a large amount of pericardial effusion with compression of the right ventricle (Figs 1 and 2).The patient was shifted to ICU after primary resuscitation for possible pericardiocentesis.In ICU, he was conscious but became more restless and tachypneic.Emergency pericardiocentesis was performed because of impending cardiac tamponade.Approximately 500 mL of pus was drained (Fig. 3), IntroductIonPericardial effusion can be caused by infectious, noninfectious, or autoimmune etiology.It is mostly diagnosed secondary to some underlying infectious etiology.Causative organisms are mainly viral.When pus is aspirated from pericardiocentesis, bacterial etiology is certain, and this condition has been named pyopericardium.In current clinical practice, pyopericardium is rarely encountered as a cause of pericardial effusion due to the availability of modern antibiotics.It is a rapidly progressive infection with a high fatality rate if went undiagnosed. 1 It can be idiopathic/primary without any underlying cause or secondary to infection elsewhere in the body, such as nosocomial bloodstream infections or underlying pericardial disease or seen in immunosuppression. 2 It has been seen as a complication of pneumonia in children and young adults.3 In an immunocompetent host, primary pyopericardium without evidence of primary focus of infection in the body is very rare.Herewith, we report a case of a 39-year-old premorbidly healthy gentleman who had near-fatal primary pyopericardium complicated by cardiac tamponade without an obvious primary cause. case descrIptIonA 39-year-old gentleman presented to the emergency department with 10 days of complaints of fever on and off, generalized weakness, and breathlessness.On clinical examination, he was found to have a pulse rate of 116/min, blood pressure of 90/64 mm Hg, a saturation of 98% on room air, raised jugular venous pressure, and muffled heart sounds without evidence of murmurs.Other systemic examinations were within normal limits.He did not complain of chest pain.