English K, Pick N, Schmitz A. Acute purulent pericarditis secondary to community-acquired streptococcus pneumonia: A case report. World J Clin Cases 2025; 13(26): 107748 [DOI: 10.12998/wjcc.v13.i26.107748]
Corresponding Author of This Article
Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, S 42nd & Emile St, Omaha, NE 68198, United States. keenglish@unmc.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 16, 2025; 13(26): 107748 Published online Sep 16, 2025. doi: 10.12998/wjcc.v13.i26.107748
Acute purulent pericarditis secondary to community-acquired streptococcus pneumonia: A case report
Kevan English, Noelle Pick, Allyson Schmitz
Kevan English, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Noelle Pick, Allyson Schmitz, Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE 68198, United States
Author contributions: English K wrote the original draft, contributed to conceptualization, writing, reviewing, and editing; Pick N and Schmitz A reviewed and edited the article; All authors read and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient regarding the publication of this article and the associated image.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, S 42nd & Emile St, Omaha, NE 68198, United States. keenglish@unmc.edu
Received: March 31, 2025 Revised: May 4, 2025 Accepted: June 13, 2025 Published online: September 16, 2025 Processing time: 117 Days and 3.8 Hours
Abstract
BACKGROUND
Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response. This condition accounts for up to 5% of emergency department visits for nonischemic chest pain in Western Europe and North America. The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes. Acute pericarditis is generally self-limited. However, some cases may be complicated by either tamponade or a large pericardial effusion, which carries a significant risk of recurrence. Risk factors for acute pericarditis include viral infections, cardiac surgery, and autoimmune disorders. A rarer cause of pericardial inflammation includes pneumonia, which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics. Purulent pericarditis carries a high fatality rate, especially in the setting of tamponade, and is invariably deadly without the administration of antibiotics. Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.
CASE SUMMARY
We present the case of a 62-year-old woman who sought medical attention at the emergency department (ED) due to a 5-day history of chest pain, shortness of breath, and subjective fevers. Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein. A chest X-ray revealed a new focal density within the left lower lung base, and a bedside point-of-care ultrasound showed a pericardial fluid collection. The patient was subsequently admitted, where she underwent pericardiocentesis. Fluid cultures from drainage grew streptococcus pneumoniae. She was started on broad-spectrum antibiotics immediately after the procedure. The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.
CONCLUSION
This case report emphasizes a unique complication of community-acquired pneumonia. Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium. This condition is virtually fatal without the administration of antibiotics. Therefore, in the context of suspected pneumonia and a new pericardial fluid collection on imaging, clinicians should suspect purulent pericarditis until proven otherwise, which requires emergent intervention.
Core Tip: Purulent pericarditis is a rare, life-threatening localized infection of the pericardial space that is fatal if left untreated. It is most commonly caused by staphylococcus aureus and streptococcus pneumoniae species. Purulent pericarditis, particularly from community-acquired pneumonia, is a rare occurrence. Diagnosis is commonly obtained via an echocardiogram, and treatment includes pericardiocentesis and antibiotic therapy. This article presents a rare case of purulent pericarditis due to community-acquired pneumonia that was successfully treated.
