Streptococcus anginosus purulent pericarditis with cardiac tamponade after coronary artery bypass surgery

Purulent pericarditis caused by Streptococcus anginosus is extremely rare. A 66-year-old man underwent elective coronary artery bypass surgery. This was complicated by sternal wound dehiscence with drainage. Subsequently, he developed fever, progressive dyspnoea and presyncope. Echocardiography showed a large pericardial effusion with evidence of tamponade. He underwent emergent pericardiocentesis. The pericardial fluid culture grew S. anginosus. He was treated with 4 weeks of intravenous ceftriaxone with complete clinical recovery. The source of infection was most likely the sternal wound which was overlooked during debridement and rewiring surgery.