Neisseria Meningitidis–Induced Septic Pericarditis Masquerading as Acute Coronary Syndrome

Background: Septic pericarditis is a rare but life-threatening condition that can mimic acute coronary syndrome (ACS). Case Summary: A 45-year-old man with diabetes and hypertension presented with acute chest pain and hypotension. Initial electrocardiogram raised suspicion for ACS; however, coronary angiography showed no coronary artery disease. The patient subsequently developed a rapidly progressive pericardial effusion and cardiac tamponade, necessitating urgent pericardiocentesis. Drained pericardial fluid was purulent and cultures confirmed Neisseria meningitidis infection. The patient received systemic antibiotics and continued drainage of pericardial fluid, resulting in complete recovery. Discussion: This case highlights the importance of considering infectious etiologies like N meningitidis in patients presenting with symptoms resembling ACS. Literature indicates that hyperinvasive strains of N meningitidis can cause severe cardiac complications, making awareness crucial for timely diagnosis and treatment. Take-Home Messages: N meningitidis can present with septic pericarditis mimicking ACS. Prompt recognition and multidisciplinary management are essential for favorable outcomes.