Acute purulent pericarditis is a dreadful disease, though it is becoming uncommon in the era of antibiotics. We present a case of Fatal Acute massive purulent pericarditis in a kidney transplant recipient. The patient had an unrelated commercial renal transplantation in 2003. She had history of diabetes mellitus, Hepatitis C infection and Kaposi sarcoma in the post transplant period. Her last admission was prompted by the development of an acute rejection that was confirmed by a transplant biopsy. She was treated with Intravenous Methyl prednisolone for this purpose. Three days before her death, thrombophlebitis of the Right forearm was noticed. We postulate that this could have been the source of the fulminant purulent pericarditis, as the organism in the pericardial fluid was a staphylococcus, the common pathogen involved in thrombophlebitis. She could be initially resuscitated but eventually succumbed to her infection. We conclude that severe purulent pericarditis in the immunocompromised patient can occur abruptly. The source may be of minimal signs and symptoms. The evolution could be shouldering. Thrombophlebitis and apparently minor infections should not be overlooked or under estimated in such patients.