Pyopericardium complicated with cardiac tamponade: an unusual presenting manifestation of primary pyomyositis.

Primary pyomyositis is an infective condition mainly involving the skeletal muscles. Various cardiac complications reported are acute bacterial endocarditis, pyogenic pericarditis, pancarditis and, very rarely, pyopericardium presenting as cardiac tamponade. We report a case of 15-year-old boy presenting with complaints of fever, progressive shortness of breath and retrosternal pleuritic chest pain. He also complained of painful swellings of left arm, left side of neck and left thigh extending up to the knee joint. Ultrasonography showed collections in the: bilateral sternocleidomastoid; subclavius; left thigh muscles; and left knee joint. Echocardiography showed evidence of cardiac tamponade. He underwent emergent pericardiocentesis and frank pus was drained. Pus culture grew Methicillin resistant Staphylococcous aureus. With drainage and the appropriate antibiotics, he improved.