Streptococcus anginosus Purulent Pericarditis With Contiguous Hepatic and Subdiaphragmatic Fluid Collections

Streptococcus anginosus is a microaerophilic, catalase-negative, gram-positive cocci, which form small colonies and produce a characteristic caramel odor when cultured on blood agar. Purulent pericarditis is a rare clinical presentation caused by this microorganism. We present a 62-year-old gentleman with multiple medical comorbidities whom had worsening shortness of breath during the last month. He presented in cardiac tamponade and computed tomographic scan of the chest, abdomen, and pelvis revealed a large pericardial effusion with contiguous subdiaphragmatic and hepatic collections. Streptococcus anginosus was isolated from pericardial fluid, and the associated subdiaphragmatic and hepatic collections completely resolved after initial and emergent subxiphoid pericardial drainage. To the best of our knowledge, this is the first known case of Streptococcus anginosus causing purulent pericarditis with associated subdiaphragmatic and hepatic collections which resolved after drainage.