Infantile Pyopericardium and Multi-Organ Dysfunction Syndrome Following Digital Paronychia: A Diagnostic Challenge

Abstract

Pyopericardium is a rare but life-threatening condition in infants, characterized by the accumulation of purulent fluid within the pericardial sac. It often presents with nonspecific clinical features, leading to delayed diagnosis and high mortality. Although commonly associated with thoracic infections, postoperative states, or hematogenous spread from systemic sepsis, its occurrence following a superficial soft-tissue infection is extremely uncommon. We report the case of an infant who developed pyopericardium and subsequent multi-organ dysfunction syndrome (MODS) following digital paronychia. The child initially presented with fever, irritability, and localized finger swelling, which progressed over several days to respiratory distress, poor feeding, and lethargy. On admission, the infant was in septic shock with tachycardia, hypotension, and signs of respiratory failure. Cardiovascular examination revealed muffled heart sounds. Laboratory investigations showed elevated inflammatory markers and metabolic acidosis. Echocardiography demonstrated a large pericardial effusion with features of cardiac tamponade. Emergency pericardiocentesis yielded thick purulent fluid, confirming the diagnosis of pyopericardium. Despite prompt drainage, broad-spectrum intravenous antibiotics, ventilatory support, and intensive care management, the clinical course was complicated by MODS involving cardiovascular, respiratory, and renal systems

Conclusions: This case highlights the potential for severe systemic complications arising from seemingly minor localized infections in infants. Early recognition of evolving sepsis, timely echocardiographic evaluation, and aggressive multidisciplinary management are crucial to improving survival outcomes in infantile pyopericardium