Acute bacterial pericarditis is a rare but devastating complication of Staphylococcus aureus bacteremia (SAB). We herein describe the case of a previously healthy 81-year-old woman with SAB complicated by pericarditis that evolved into cardiac tamponade despite the administration of optimal antimicrobial therapy for 11 days. Three adhesion factor genes, fnbA, clfA and clfB, were identified in the causative isolate.