Purulent Pneumococcal Pericarditis Presenting as Normotensive Cardiac Tamponade in Austrian Syndrome

Austrian syndrome is a rare manifestation of invasive Streptococcus pneumoniae infection. Purulent pneumococcal pericarditis causing cardiac tamponade is an exceptionally uncommon but life-threatening complication.

A 63-year-old unhoused woman presented with altered mental status and respiratory failure. Despite preserved blood pressure, electrocardiography demonstrated electrical alternans, and point-of-care echocardiography revealed cardiac tamponade. Pericardiocentesis yielded purulent fluid growing S pneumoniae. Systemic emboli and echocardiographic findings were consistent with Austrian syndrome complicated by purulent pericarditis and cardiac tamponade. Despite medical and surgical management, the patient developed refractory shock and died.

Purulent pneumococcal pericarditis may present with tamponade despite normotension or hypertension. Early recognition and prompt drainage are critical.

Cardiac tamponade may occur despite preserved blood pressure. Electrical alternans and point-of-care echocardiography are key diagnostic clues. Purulent pericarditis often requires surgical drainage and carries high mortality.