Pericarditis as a rare complication of pneumococcal pneumonia in a young infant

Purulent pericarditis is an exceptionally rare complication of pneumococcal pneumonia in infants but a rapidly fatal disease if left untreated. A previously healthy 4-month-old boy presented at our emergency department with a 10-day history of fever and non-productive cough. No signs of heart failure or cardiac friction rub were evidenced. Chest radiography showed lobar pneumonia, right pleural effusion and cardiomegaly. Echocardiography revealed a massive pericardial effusion, and an emergency drainage was performed. Streptococcus pneumoniae grew up from purulent pericardial fluid and blood cultures. After intravenous antibiotherapy, the outcome was favourable. The introduction of the pneumococcal vaccine may favour an increase in the incidence of non-vaccine serotypes which most commonly cause empyaema and perhaps pericarditis. Therefore, pericarditis should always be considered a possible complication in patients with pneumococcal pneumonia and empyaema.