A Case of Slowly Progressive Purulent Pericarditis in Elderly Healthy Woman

Abstract

A 67-year-old woman was admitted with dyspnea. The cheat X-ray showed marked cardiomegaly and the echocardiography revealed diffuse massive pericardial effusion but no finding of vegetation on valves. Clinical sign of cardiac tamponade was not observed. Values of white blood cell and C-reactive protein were 23,900/μL and 16.2 mg/dL, respectively. Immediately, pericardiocentesis was performed. Pericardial effusion was yellowish purulent exudate and Streptococcus pneumoniae was detected in culture. The early pericardial drainage and the effective doses of intravenous antibiotics and γ-globulin were successful for the treatment of this bacterial pericarditis, and no more surgical procedure was needed. Neither recurrence of inflammation nor constrictive pericarditis was developed after discontinuation of antibiotics during the follow-up period for over three years at the outpatient clinic. In this case, an infection route was unknown since pneumonia, empyema, or other focus of infection was not found. Although she had an upper respiratory infection one year prior to this pericarditis, their association was unclear. She was previously healthy and was not a compromised host. This case is thought to be rare bacterial pericarditis with slow progression in the recent antibiotic era.