Massive pericardial effusion: two rare aetiologies in one patient

We present the case of a 64-year-old, immunocompetent woman with untreated hypothyroidism, who was admitted with massive pericardial effusion. She had no clinical signs or echocardiographic evidence of pericardial tamponade. To our surprise, cultures of pericardial fluid grew salmonella enteritidis. Hypothyroidism is a known, but rare cause of pericardial effusion. Due to its insidious onset and slow fluid accumulation, it may develop unnoticed by clinicians. Pericardial infection with nontyphoidal salmonella is an extremely exceptional finding in immunocompetent subjects. Because preexisting pericardial fluid acts as a culture medium, it might rather be the result of superinfection of preexisting pericardial effusion during bacteraemia than primary salmonella pericarditis.