We present the case of a 59 year old woman with no previous clinical history of disease who was admitted in our ICU due to respiratory failure and hemodynamic instability. She was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by massive pericardial effusion and pleural empyema. A pericardial tap was performed unsuccessfully and finally pericardial effusion was evacuated by surgical drainage. Pleural empyema was also evacuated. She received antibiotic treatment and recovered with normalisation of heart function.