Cardiac Tamponade Secondary to Streptococcus pneumoniae-Associated Purulent Pericardial Effusion in an Immunocompetent Young Adult With Heavy Tobacco Exposure

We describe a case of a 41-year-old immunocompetent Caribbean South Asian man with a 25-pack-year smoking history who presented with cardiac tamponade secondary to a Streptococcus species-associated purulent pericardial effusion (PPE), with clinical and microbiological findings suggestive of Streptococcus pneumoniae.The patient underwent emergent pericardiocentesis with drainage of 600 mL of frank purulent fluid, followed by video-assisted thoracoscopic surgery with pericardial window and washout.He progressed from obstructive to septic shock and was successfully managed with combined surgical drainage, broadspectrum antimicrobial therapy, and adjunctive colchicine.The clinician should maintain a high index of suspicion for PPE as a cause of cardiac tamponade, even in the immunocompetent host, and consider invasive pneumococcal disease as a potential etiology in patients with heavy tobacco exposure.