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

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.