Septic Pneumopericardium in A Patient with Sepsis Due To Gluteal Cellulitis: A Case Report

Background: Pneumopericardium is an uncommon and potentially life-threatening condition defined as the presence of air in the pericardial sac. It is most frequently secondary to trauma, iatrogenic injury, or barotrauma, while infectious etiologies remain rare but highly lethal. Case Presentation: We report a 77-year-old man with type 2 diabetes mellitus, hypertension, and chronic alcohol use disorder who presented to the Emergency Department with fever, dyspnea on exertion, orthopnea, and left gluteal cellulitis. Laboratory investigations revealed leukocytosis, markedly elevated C-reactive protein and procalcitonin, hyperlactatemia, and mixed metabolic–respiratory acidosis. Whole-body CT demonstrated pneumopericardium with bilateral pulmonary infiltrates. The patient was managed according to the Surviving Sepsis Campaign bundle, started on broad-spectrum antimicrobial therapy, and underwent pericardial drainage. Conclusion: Although rare, pneumopericardium should be considered in septic patients with thoracic complaints. Early recognition, rapid imaging, aggressive antimicrobial therapy, and urgent source control are critical for survival.