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Medical City Arlington
Purulent pericarditis, pericarditis, Staphylococcus aureus
Bacterial Infections and Mycoses | Cardiovascular Diseases | Internal Medicine
Introduction Purulent pericarditis is a rare illness in the modern age of medicine due to the increased usage of antibiotics. Unfortunately, diagnosis of this disease is often delayed due to its nonspecific symptoms. Without treatment, the mortality is nearly one hundred percent due to major complications such as cardiac tamponade and constrictive pericarditis. As a result, most cases of purulent pericarditis are discovered post-mortem. This case report details an early diagnosis of purulent pericarditis secondary to methicillin-sensitive Staphylococcus aureus (MSSA) in an end-stage renal disease (ESRD) patient. Case Presentation A 66-year-old female with past medical history of ESRD initially presented to the emergency room complaining of shortness of breath for the past few days. She denied any other symptoms including fevers, chills or chest pain at the time. She was initially admitted inpatient and scheduled for immediate hemodialysis. She was unable to tolerate hemodialysis due to respiratory distress and was kept inpatient for another night. On the second night of hospitalization, patient developed a fever of 102.2 degrees Fahrenheit. Blood cultures were drawn at the time which grew positive for MSSA two days later. A CT scan of the abdomen and pelvis along with a transthoracic echocardiogram were ordered, both of which showed a large pericardial effusion with fibrinous strands suspicious for loculations. Cardiothoracic surgery was consulted for suspected purulent pericarditis. A pericardial window was performed which drained 700 mL of purulent fluid. Patient was subsequently treated with eight weeks of intravenous cefazolin and gentamicin without any complications. Learning Points Patients with purulent pericarditis can present only with nonspecific symptoms such as fevers and lack common features of pericarditis such as chest pain or pericardial friction rub. There should be a low threshold for suspecting purulent pericarditis in patients with MSSA bacteremia and fevers. If diagnosed early on, patient can be treated with drainage of the pericardium and directed antimicrobial therapy before complications such as cardiac tamponade or constrictive pericarditis can arise.
HCA Healthcare Graduate Medical Education
Shey, Stephen; Espinosa-Tello, Alejandro; and Andrabi, Amnah, "Early Diagnosis of Purulent Pericarditis Secondary to Methicillin-Sensitive Staphylococcus Aureus in an End-Stage Renal Disease Patient" (2023). North Texas Research Forum 2023. 33.