Primary purulent bacterial pericarditis due to Streptococcus intermedius in the absence of an esophago-pericardial fistula

Purulent bacterial pericarditis is a rare and progressive infection with a high mortality. It is rarely due to Streptococcus intermedius, a commensal bacteria found in the oral cavity, gastrointestinal tract, and the genitourinary tract. Here we present a 71-year-old man with history of esophageal adenocarcinoma, status post distal esophagectomy and proximal gastrectomy 2 years prior, who developed cardiac tamponade secondary to primary S. intermedius purulent bacterial pericarditis in the absence of an esophago-pericardial fistula. We discuss the clinical manifestations of bacterial pericarditis and pericardial effusions, useful diagnostic tools, and explore possible mechanisms for S. intermedius pericarditis infection. This case highlights the importance of prompt suspicion, recognition, and intervention for bacterial pericarditis and cardiac tamponade in the setting of recent esophageal instrumentation. In addition, despite being rare, S. intermedius should be recognized as a possible pathogen in purulent bacterial pericarditis even with the absence of an esophago-pericardial fistula.