31 January 2026
: Case report 
Cell-Free DNA Reveals Hidden Streptococcus anginosus in Cryptogenic Purulent Pericarditis in a Young Adult
Challenging differential diagnosis, Rare disease
Rafael Lessa Da Costa
ABDEF 1*, Natalia Viana Lopes Pereira BD 1, Ricardo Mendes Carneiro BD 1, Flavia Prado Fialho Santos BD 1, Julia Paulo Mourilhe Rocha BD 1, Flavio De Souza Afonso BD 1, Luciana Fazzio De Andrade BD 1, Paula Riedlinger Mont'Alverne Bordalo BD 1, Leticia Da Silva Alves BD 1, Pedro Castello Branco De Moraes BD 1, Gustavo Salgado Duque ABDF 1, Ricardo Mourilhe-Rocha ADEF 1
DOI: 10.12659/AJCR.951258
Am J Case Rep 2026; 27:e951258
Table 2 Cases of purulent pericarditis caused by bacteria from the Streptococcus anginosus group and their characteristics.
| Country, year [reference] | Sex, age (y) | Agent | Diagnostic method | Tamponade | Risk factor | Death |
|---|---|---|---|---|---|---|
| Japan, 1988 []14 | M, 42 | Pericardial fluid cultures | No | No | NI | |
| Japan, 1991 []9 | M, 55 | Pericardial fluid cultures | No | Lung cancer, alcohol and cigarette abuse | No | |
| USA, 1992 []15 | M, 63 | Pericardial fluid cultures | Yes | Lung cancer, surgical contamination | Yes | |
| Spain, 1993 []16 | NI, NI | Pericardial fluid cultures | NI | Peritonitis | NI | |
| NI, NI | Pleural fluid | NI | Oral sepsis | NI | ||
| USA, 1999 []17 | F, 20 | Pericardial fluid cultures | Yes | Post vaginal delivery | No | |
| Japan, 1999 []18 | NA, NA | NA | NA | Esophageal carcinoma | NA | |
| NA, NA | NA | NA | Esophageal carcinoma | NA | ||
| Belgium, 2000 []19 | F, 71 | Pericardial fluid cultures | No | No | No | |
| Spain, 2002 []20 | M, 54 | Pericardial fluid cultures | No | NI | NI | |
| USA, 2003 []21 | M, 47 | Pericardial fluid cultures | No | Esophageal carcinoma, liver metastasis, esophagopericardial fistula | Yes | |
| Poland, 2004 []22 | F, 40 | Pericardial fluid cultures | NI | Pneumonia | No | |
| Japan, 2009 []23 | F, 69 | Pericardial fluid cultures | Yes | Pneumonia, untreated diabetes | No | |
| China, 2013 []24 | M, 14 | Pericardial fluid cultures | No | Dental abscess | No | |
| Japan, 2013 []25 | F, 56 | Pericardial fluid cultures | No | Esophageal carcinoma, esophagopericardial fistula | Yes | |
| USA, 2014 []26 | F, 1 y, 1 mo | Pericardial fluid cultures | No | Pericardial teratoma | No | |
| United Kingdom, 2015 []27 | M, 65 | Pericardial fluid cultures | No | Rheumatoid arthritis, corticosteroids, dental procedures | No | |
| Turkey, 2015 []28 | M, 19 | Pericardial fluid cultures | NI | Pneumonia | No | |
| Qatar, 2016 []29 | M, 19 | Pericardial fluid cultures | Yes | Pneumonia | No | |
| Afghanistan, 2017 []30 | M, 24 | Pericardial fluid cultures | Yes | No | No | |
| USA, 2018 []31 | M, 33 | Pericardial fluid cultures | Yes | No | No | |
| USA, 2020 []32 | M, 66 | Pericardial fluid cultures | Yes | Coronary artery bypass graft surgery, uncontrolled diabetes | No | |
| Korea, 2020 []33 | F, 69 | Blood and pericardial fluid cultures | Yes | No | No | |
| Thailand, 2020 []34 | M, 31 | Pericardial fluid cultures | No | Liver abscess | No | |
| Japan, 2020 []35 | M, 66 | Pericardial fluid cultures | No | Esophageal cancer, gastric reconstruction | NI | |
| USA, 2021 []36 | F, 66 | Pericardial fluid cultures | NI | Metastatic adenocarcinoma | No | |
| Portugal, 2021 []37 | M, 54 | Pericardial fluid cultures | Yes | Pneumonia | No | |
| Malaysia, 2023 []38 | M, 41 | Heart and liver tissue cultures | NI, post mortem | Liver abscess | Yes | |
| Lithuania, 2023 []39 | M, 45 | Pericardial fluid cultures | No | No | No | |
| USA, 2024 []40 | M, 50 | Pericardial fluid cultures | Yes | Sarcoidosis, corticosteroid | No | |
| – ; – ; – ; – ; – ; – ; – ; M – Male; F – Female; mo – months; NA – not assessed; NI – not informed. | ||||||