Purulent Pericarditis and Tamponade From a Migrating Esophageal Foreign Body.

backgroundPurulent pericarditis is rare, typically affecting immunocompromised individuals from hematogenous spread, contiguous extension, or direct inoculation. Esophageal foreign body migration as an etiology has not been previously described. CASE SUMMARY: A 42-year-old immunocompetent male presented with pleuritic chest pain and dysphagia after ingestion of a tripe burrito. He developed hemodynamic instability from cardiac tamponade. Emergent pericardiocentesis was performed, yielding fluid that grew Streptococcus constellatus. Computed tomography and esophagogastroduodenoscopy identified a penetrating foreign body in the distal esophagus. He improved following video-assisted pericardial washout and antibiotic therapy. Follow-up imaging demonstrated migration of the object between the thoracic aorta and azygos vein. DISCUSSION: Rare cases of purulent pericarditis in immunocompetent patients have been reported via respiratory translocation; however, this appears to be the first reported case of purulent pericarditis due to esophageal foreign body migration. Multidisciplinary consensus supported conservative management rather than surgical pericardiectomy and led to a full recovery. TAKE-HOME MESSAGES: Early recognition of purulent cardiac tamponade due to foreign body ingestion, along with prompt pericardiocentesis and antibiotic therapy, was critical for stabilization and individualized management.