Pyopericardium progressing to cardiac tamponade in a patient with dengue fever

Pyopericardium is a rare cause of cardiac tamponade. We present a case of a dengue fever patient who presented with cellulitis of the upper limbs, later manifesting cardiac tamponade, which was fatal. Although echocardiography on admission revealed a small pericardial effusion only, it later manifested as tamponade, causing cardiogenic shock. Staphylococcus pyopericardium was found later. Early identification could be possible with bedside point-of-care ultrasonography and echocardiography. Emergent pericardiocentesis or pig tail drain placement is life saving. • Dengue is an important public health problem. • It may present with mild symptoms or severe form of dengue hemorrhagic fever. • Cardiac tamponade patients are usually anxious, with dyspnea and chest pain. • Early identification is possible with bedside ultrasonography. • Emergent pericardiocentesis or pig tail drain placement is life saving.