Nocardia asteroides purulent pericarditis

A case is reported of a 71-year-old woman who developed cardiac tamponade as a result of a pyopericardium. The causative organism was Nocardia asteroides. This is the first reported case in the United Kingdom and only the 9th to be reported in the world. Despite prior radiological and echocardiographic investigations, we were unprepared at surgery for the volume of pus encountered. The dense adhesions, adherent pericardium and loculations encountered emphasizes the need to explore such patients surgically. We would advocate vigilance as to the possibility of pericardial involvement, in any patient contracting Nocardia asteroides infection. The medical and surgical management of this case is discussed together with a review of the literature.