Candida Cardiac Tamponade Secondary to Oesophageal-Pericardial Fistula: A Rare Presentation of Oesophageal Squamous Cell Carcinoma

Candida is a rare cause of purulent pericarditis. Oesophago-pericardial fistula is an uncommon and potentially life-threatening complication of both benign and malignant oesophageal tumours. Here we report the case of 40-year-old woman who presented with symptoms and signs suggestive of acute pericarditis complicated by cardiac tamponade which required acute management with paracentesis. Pericardial fluid analysis was positive for Candida albicans. Oesophagogastroduodenoscopy was performed and revealed a small fistula in the proximal oesophagus extending into the retrocardiac space. Multiple biopsy specimens of the fistula site and oesophageal stricture were obtained. Histopathological findings were consistent with poorly differentiated squamous cell carcinoma of the oesophagus complicated by fistulation to the retrocardiac space. LEARNING POINTS: Purulent pericarditis with atypical organisms should raise the suspicion of oesophago-pericardial fistula. Oesophago-pericardial fistula in oesophageal squamous cell carcinoma is rare and associated with high mortality and a poor prognosis. This is one of the few cases where a gastro-pericardial fistula has been diagnosed by endoscopy.