From oesophageal cancer to constrictive pericarditis: oesophagopericardial fistula complicated by Streptococcus equi infection—a case report

Oesophagopericardial 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.

A 50-year-old horse handler with advanced oesophageal 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 oesophagopericardial 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.

This case highlights a rare zoonotic cause of purulent pericarditis and its progression to constrictive physiology despite appropriate management.

Early recognition, multidisciplinary management, and follow-up imaging are essential in complex pericardial infections.