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A 67-year-old male patient presented to the emergency department with a 2-week history of spike fevers, anorexia, asthenia, and orthostatic breathing. He had chronic cholecystitis and diabetes for 10 years. Epigastralgia and weight loss appeared 4 months before admission. His blood pressure was 131/70 mmHg. The 12-lead electrocardiograms showed atrial fibrillation with rapid ventricular response (114 b.p.m.) and ST segment elevation in I, II, III, aVL, aVF, and V4-6 leads. The chest X-ray presented cardiomegaly. A 15-mm distance of diffuse pericardial effusion was noted on emergent bedside echocardiography, though right ventricular diastolic collapse was not observed, which might be the results of the gradual increase of pericardial effusion. Computed tomography revealed two liver abscesses with large cystic lesions in the left hepatic lobe (Figure 1A). Pericardiocentesis and percutaneous catheter drainage of liver abscess yielded purulent yellow fluid, by which Klebsiella pneumoniae was cultured. Broad-spectrum antibiotic therapy with vancomycin and meropenem was initiated and changed to sulbactam/ampicillin on the 6th day. To assess the connection between two liver abscesses, 5 mL of 60% urografin was injected into the liver abscess; the pericardial space was unpredictably enhanced (Figure 1B). Purulent yellow fluid continued to drain for 30 days and the signs of inflammation had improved gradually. The echocardiography also showed abnormal ventricular septal motion with respiratory variation on admission which had been observed until discharge (Figure 2A, Supplementary material online, Video S1). The finding of early rapid filling and equalization of left and right ventricular end-diastolic pressure was obtained by right-heart catheterization. Comparatively, there was an increase in the right ventricular pressure curve area during inspiration, suggesting constrictive pericarditis (CP) (Figure 2B). Overall, we diagnosed purulent pericarditis and CP caused by

A case with purulent pericarditis diagnosed by the unintended pericardiography