Parasternal Pericardiocentesis for Methicillin-Resistant Staphylococcus aureus Pericarditis Complicated by Abscess and Tamponade.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) pericarditis is a rare infection, with high morbidity and mortality rates. CASE SUMMARY: A 70-year-old woman with a past medical history of multiple myeloma, atrial fibrillation, cirrhosis, and heart failure with reduced ejection fraction presented with chest pain and dyspnea. MRSA bacteremia from an infected central venous port led to septic shock and an anterior pericardial abscess, causing cardiac tamponade. Urgent parasternal pericardiocentesis was performed, with fluid cultures positive for MRSA. Despite tamponade resolution, the patient's condition deteriorated, and she was transitioned to comfort care. DISCUSSION: This is to our knowledge the first reported use of parasternal pericardiocentesis for MRSA pericarditis. The case underscores the complexity of managing rare infectious pericardial complications. TAKE-HOME MESSAGES: MRSA pericarditis may cause abscess and cardiac tamponade, requiring a nontraditional pericardiocentesis approach. Despite interventions, outcomes remain poor owing to infectious sequelae.