Localized massive staphylococcal pericardial abscess with atypical presentation

Localized staphylococcal pericardial abscess (PA) is extremely rare and highly mortal complication of Staphylococcus aureus bacteremia with only a few reported cases in English-language medical literature. Clinical manifestations are fulminant, and early management is necessary. Here we report a case of end stage renal disease (ESRD) with isolated localized massive staphylococcal PA and had masked signs and symptoms of pericardial staphylococcal infection. Contrast-enhanced computed tomography scan suggested anterior massive localized pericardial cyst like image. Surgical drainage of the abscess with localized pericardiectomy conjugated with antibiotic therapy led to a successful management. Staphylococcus aureus is the leading cause of hemodialysis catheter-related bloodstream infections, contributing 33–80% of the organisms cultured from blood samples. Nature of staphylococcal pericardial infection is aggressive and life threatening with generalized involvement of the pericardium although our patient presented with masked signs and symptoms. CT image of localized pericardial lesion with masked signs and symptoms does not exclude the presence of live threating pericardial infection, especially in immunocompromised patients. •Localized staphylococcal pericardial abscess is an extremely rare condition with only a few reported cases in English-language medical literature.•CT images of localized pericardial abscess mimics with that of pericardial cysts, and can lead to misdiagnosis; this is particularly true when there is an indolent presentation of the condition caused by immunosuppression.•Successful management can be achieved through surgical drainage of the abscess antibiotic therapy according to the bacterial sensitivity.