From Esophageal Cancer to Constrictive Pericarditis: Esophagopericardial Fistula Complicated by Streptococcus equi Infection- a case report

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ID: 328932
2026
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Abstract
Abstract Background Esophagopericardial fistula is a rare but life-threatening condition that may lead to purulent pericarditis, which in turn carries a high risk of progression to constrictive pericardial disease. Case summary A 50-year-old horse handler with advanced esophageal carcinoma presented with acute chest pain, fever and shock. Echocardiography showed a large pericardial effusion and pericardiocentesis yielded purulent fluid. Streptococcus equi was isolated. Computed tomography confirmed an esophagopericardial fistula. The patient underwent percutaneous drainage, broad-spectrum antimicrobial therapy and endoscopic stent placement. Despite initial improvement, he developed effusive-constrictive physiology and later refractory septic shock, leading to death. Discussion This case highlights a rare zoonotic cause of purulent pericarditis and its progression to constrictive physiology despite appropriate management. Take-home messages Early recognition, multidisciplinary management and follow-up imaging are essential in complex pericardial infections.
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Authors Sofia Esteves, Ana Rita Figueiredo, J Rigueira, Catarina Sousa, Fausto J. Pinto
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag700
URL
https://doi.org/10.1093/ehjcr/ytag700
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