A Rare Dual Etiology of Gastropericardial Fistula in a Child: Gastric Malignancy with Candida Infection Leading to Pyopneumopericardium

Abstract

Background: Pyopneumopericardium due to gastropericardial fistula with candida pericarditis is very uncommon in pediatric age group and with extremely high mortality. To the best of our knowledge this is the first case report of this kind in the pediatric literature. Case Presentation: A 4 year old female child was referred from a pediatric tertiary care facility with history of fever, cough, fast breathing and subjected to pericardiocentesis in the referral centre in view of hydropneumopericardium with cardiac tamponade. Despite aggressive antibiotic administration and recurrent pericardial aspiration the general condition of the patient had a deteriorating course. The culture of candida in the pericardial fluid gave a clue to the presence of immunosuppression. She was diagnosed with candida pericarditis, persistent pneumopericardium secondary to gastropericardial fistula on account of gastric malignancy. She could not survive because of poor general condition on account of late and unusual presentation of gastric malignancy. Conclusion: Non resolving pyopneumopericardium must always be investigated for candida pericarditis and its attendant cause of immunosuppression. Also an abnormal connection between the pericardial sac and any hollow viscera should be suspected. Early recognition and aggressive management will be life saving in such condition.