A rare case of purulent pericarditis arising from a hepato‑pericardial fistula

Khaled Alaboud Alkheder; Omar Farooq Al‑Nahhas; Yousif Basim Al‑Khafaji; Ammar Alshirazi Alssabagh; Sudarshana Reddy Thiyyagura

doi:10.4103/tjem.tjem_256_24

Khaled Alaboud Alkheder¹, Omar Farooq Al‑Nahhas¹, Yousif Basim Al‑Khafaji¹, Ammar Alshirazi Alssabagh², Sudarshana Reddy Thiyyagura¹

¹Department of Emergency, Tawam Hospital, Al Ain, UAE
²Department of General Surgery, Tawam Hospital, Al Ain, UAE

Keywords: Bacterial infections, echocardiography, Enterobacter infections, hepatic abscess, hepato‑pericardial fistula, multidisciplinary care, pericardial effusion, pericardiectomy, purulent pericarditis, sepsis

Abstract

Purulent pericarditis is a rare but severe complication of bacterial pericarditis, often secondary to intrathoracic infections, and can cause a hepatic abscess that ruptures into the pericardium, which is an uncommon symptom with a high mortality rate if untreated. We report on a 52 year old man with a poorly differentiated hepatocellular carcinoma who presented with chest pain and pericardial effusion caused by a hepato pericardial fistula. Imaging revealed hepatic microabscesses extending into the pericardium. The patient underwent a pericardial window procedure with purulent fluid drainage and was treated with meropenem for Enterobacter cloacae. Postoperatively, the bilateral pleural effusions required chest drains. After 3 weeks of multidisciplinary care, the patient was discharged in a stable condition. This case highlights the importance of early diagnosis and a multidisciplinary approach in managing rare complications of purulent pericarditis caused by hepatic abscesses. Timely surgical intervention and appropriate antibiotic therapy are crucial for favorable outcomes.

How to cite this article: Alkheder KA, Al‑Nahhas OF, Al‑Khafaji YB, Alssabagh AA, Thiyyagura SR. A rare case of purulent pericarditis arising from a hepato‑pericardial fistula. Turk J Emerg Med 2026;26:75-7.