Surgical drainage of 500 mL of pericardial fluid and 400 mL of hepatic abscess fluid, followed by 6 weeks of ceftriaxone, successfully treated a 64-year-old man with a rare bacterial co-infection.
Case Report (n=1)
This case highlights the rare transdiaphragmatic spread of a pyogenic liver abscess causing purulent pericardial effusion and tamponade, emphasizing the need to evaluate intra-abdominal sources in such presentations.
Abstract Introduction Pyogenic liver abscess (PLA) is a serious and potentially life-threatening infection. Its association with purulent pericardial effusion is rare and of those linked to PLA, Klebsiella pneumoniae is the most frequently isolated organism. This depicts the first reported case of purulent pericardial effusion resulting from transdiaphragmatic extension of a liver abscess caused by Salmonella species and Streptococcus anginosus. Case presentation A 64-year-old man with a history of diabetes presented to the emergency department with sudden-onset shortness of breath and chest pain for one day. On arrival, he was hypotensive to 70/50 mmHg, fluid-responsive, tachycardic to 120 bpm, and on clinical examination had jugular venous distension. Initial laboratory evaluation revealed a serum lactate of 12.2 mmol/L. Bedside transthoracic echocardiography was consistent with cardiac tamponade physiology. CT of the abdomen and pelvis revealed a moderate-to-large pericardial effusion with features suggestive of pericarditis, multiple hepatic lesions concerning hepatic abscess and cholelithiasis. Cardiothoracic surgery was emergently consulted, and the patient underwent a pericardial window, draining approximately 500 mL of purulent fluid. Intraoperatively, a defect in the central fibrous pericardium was identified, directly communicating with a hepatic abscess cavity. Postoperatively, the patient was transferred to the medical intensive care unit, mechanically ventilated, and started on dual vasopressor support with norepinephrine and vasopressin for predominantly septic shock. An ultrasound-guided drainage of a hepatic abscess was subsequently performed, yielding 400 mL of purulent material. Cultures from both the pericardial fluid and the hepatic abscess grew Salmonella species and Streptococcus anginosus group organisms. Antibiotic therapy was narrowed to intravenous ceftriaxone based on susceptibility results.The patient’s vasopressor requirements declined and he was successfully extubated. Repeat CT imaging showed near-complete resolution of the pericardial effusion. The patient completed a prolonged antibiotic course for six weeks. He was subsequently discharged in stable condition with close outpatient follow-up. Discussion Pyogenic liver abscess (PLA) secondary to Salmonella species and Streptococcus anginosus is uncommon. Cases attributed to Salmonella species have predominantly been reported in association with preexisting hepatobiliary conditions, such as cholelithiasis, as was observed in our patient. The diagnosis of purulent pericardial effusion remains challenging due to its nonspecific clinical presentation, which may delay treatment. Hemodynamic instability in such cases frequently reflects a mixed shock state—combining cardiogenic, obstructive, and septic elements—necessitating an individualized and multidisciplinary therapeutic approach. Importance Given the potential for transdiaphragmatic spread of infection, clinicians should consider underlying intra-abdominal sources, such as PLA, when evaluating cases of purulent pericardial effusion. This abstract is funded by: None
Pragya et al. (2026) conducted a case report in Purulent pericardial effusion with pyogenic liver abscess (n=1). Pericardial window, hepatic abscess drainage, and intravenous ceftriaxone was evaluated on Resolution of pericardial effusion and septic shock. Surgical drainage of 500 mL of pericardial fluid and 400 mL of hepatic abscess fluid, followed by 6 weeks of ceftriaxone, successfully treated a 64-year-old man with a rare bacterial co-infection.