A Rare Case of Acute Purulent Pericarditis Secondary to Invasive Streptococcal Infection (S. pyogenes) with Cardiac Tamponade in an Immunocompetent 37-Year-Old Female

Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, Viridans streptococci, Haemophilus influenzae and anaerobic bacteria with Streptococcus pyogenes (S. pyogenes) being a possible, though very uncommon etiology. This case represents an occurrence of S. pyogenes pericarditis in an apparently healthy female with no known immunocompromising condition. A 37-year-old female, married, real estate agent with no comorbidities came in for chest pain radiating to the upper back, relieved with leaning forward. Cardiac biomarker was normal, ECG demonstrated diffuse ST-segment elevation and PR segment depression, while imaging showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance and workup for immunocompromised state was negative. The 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done. Cultures grew Streptococcus pyogenes confirming the diagnosis of acute purulent pericarditis. Daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics and the patient had resolution of pericardial effusion. Acute pyogenic pericarditis with cardiac tamponade is a rare but serious condition that requires prompt recognition and intervention. Early diagnosis, through a combination of clinical suspicion, ECG and echocardiography is crucial for initiating timely treatment. Keywords: Acute purulent pericarditis, cardiac tamponade, pericardial effusion, S. pyogenes, case report