Case Report: Acute methicillin-sensitive

Introduction: Bacterial pericarditis is rare in the antibiotic era but remains potentially fatal due to rapid progression and high mortality. Herein, we report an unusual case of methicillin-sensitive Patient concerns and clinical findings: A 47-year-old female patient with a history of presumptive ischemic cardiomyopathy, uncontrolled DM (a glycated hemoglobin level of 14.2%), and treated pulmonary tuberculosis (TB) presented with pleuritic chest tightness, fever, and dyspnea. Examinations and investigations revealed a moderate-to-large pericardial effusion, ST-segment elevation on an electrocardiogram, and high inflammatory markers. Imaging showed a pericardial effusion, raising suspicion for bacterial pericarditis. Pleural tap of an adjacent pleural effusion nearby was however transudative. Diagnosis interventions and outcomes: Pericardiocentesis was not feasible due to the loculated pericardial effusion and absence of a safe window; however, Conclusion: This case emphasizes the need to consider bacterial etiologies, including MSSA, when evaluating pericarditis in immunocompromised patients, especially those with DM or prior TB. Multimodal imaging, molecular diagnostics, and early surgical consultation are important in cases where pericardiocentesis is not feasible. Invasive diagnostic strategies may be critical for achieving a microbiological diagnosis and ensuring timely source control. Multidisciplinary collaboration is essential when managing complex pericardial infections to optimize diagnostic certainty and outcomes.