A Rare Case of Fungal Pyopericardium with Myocardial Dysfunction in a Child with Diamond-Blackfan Anemia

Pyopericardium is an uncommon yet potentially fatal paediatric emergency, typically of bacterial origin, but increasingly linked to opportunistic fungal pathogens in immunocompromised individuals. This report delineates the clinical progression of a 2-year-old female with transfusion-dependent Diamond-Blackfan Anaemia (DBA), who exhibited a one-month history of insidious fever, ultimately leading to acute cardiac tamponade. When the patient was admitted to the hospital in an emergency, they had low blood pressure (80/50 mmHg), muffled heart sounds, and severe breathing problems. Laboratory tests showed very low levels of haemoglobin (5.2 g/dL) and very high levls of inflammatory markers. An echocardiogram showed a huge pericardial effusion with right ventricular diastolic collapse and a reduced ejection fraction of 40%. Emergent pericardiocentesis produced 150 mL of purulent fluid, with cultures identifying Candida glabrata as the etiological agent. Management required a multi-faceted approach that included an emergent subxiphoid partial pericardiectomy, inotropic support, and blood transfusions. Antifungal treatment started with liposomal amphotericin B and was successfully switched to oral voriconazole after confirming that the patient was susceptible. Before being discharged on hospital day 19, the patient's heart function had improved so much that their ejection fraction was back to normal at 55%. This case shows how hard it is to diagnose fungal pyopericardium in people with congenital bone marrow failure syndromes. It also shows how important it is to do echocardiographic screening early and use aggressive surgical-pharmacological synergy to lower the high death rates that come with a late diagnosis.