Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report

Abstract

IntroductionNon-typhoidal Salmonella (NTS) is mostly restricted to gastroenteritis; however, we report a case of Salmonella pericarditis complicated by tamponade and spontaneous ventricular wall rupture.Case presentationA 67-year-old male presents to the Emergency Department with complaints of fevers, chills and body aches. A chest radiograph displayed an infiltrate and an electrocardiogram suggested acute pericarditis. An echocardiogram revealed a small pericardial effusion without tamponade. Broad-spectrum antibiotics were initiated until Salmonella was discovered in blood cultures. The hospital course was complicated by sudden decompensation, and a repeat echocardiogram displayed a large effusion with constrictive physiology. During a pericardial window, the tissue was noted to have a thickened appearance with a complex effusion. The following day, the patient developed increased chest tube drainage, hypotension and acidosis, requiring an emergent sternotomy. The right ventricle was friable and had spontaneously ruptured. After ventricular repair and pericardiectomy, the tissue was sent for cultures and pathology. The specimen revealed Salmonella enteriditis. Treatment with ceftriaxone and ciprofloxacin was initiated. On postoperative day four, the patient was successfully extubated. Repeat blood cultures were negative.DiscussionIn our review of literature, only 19 cases of NTS pericarditis have been reported. Prior to our case, salmonellosis resulting in ventricular rupture has been reported once. Early diagnosis and treatment is crucial in minimizing morbidity and mortality. Clinical suspicion based on electrocardiogram and hemodynamic assessment is critical in suspecting pericardial effusion in a patient with nonspecific symptoms and Salmonella bacteremia. The key to recovery involves aggressive treatment, including pericardiectomy and antibiotic treatment.

Invasive Non-Typhoidal Salmonella in an Immunocompetent Host

“…Invasive disease can have serious end organ damage including pericardial seeding resulting in cardiac tamponade and ventricular wall rupture [9], endocarditis, and arthritis [10]. Salmonella bacteremia is treated with monotherapy for 10 -14 days.…”

“…Salmonella responds well to fluoroquinolones and thirdgeneration cephalosporins which are the preferred drug classes in the United States. However, there are reports of emerging resistance to the fluoroquinolones worldwide [10]. In developing countries, azithromycin is the preferred empirical treatment and can be combined with ceftriaxone for life-threatening situations.…”

DisseminatedSalmonellainfection

“…In this modern antibiotic era, the prevalence of purulent pericarditis and pleuritis are rare. Based on the literature review pertaining to salmonellosis with purulent pericarditis, only four reported cases have been published so far 9–12. To the best of the researchers’ knowledge, this is the first reported case of salmonellosis involving pericardial and pleural empyema in Malaysia.…”

Purulent Pericarditis with <i>Salmonella enterica</i> Subspecies <i>arizona</i> in a Patient with Type 2 Diabetes Mellitus

“…Purulent pericarditis is rare in the modern antibiotic era and it is commonly caused by Gram-positive bacteria, which tend to directly spread from an intrathoracic focus ( 1 , 2 ). Although Salmonellosis, an infection due to Salmonella bacteria, is common worldwide, Salmonellae are rarely reported as causative agents of purulent pericarditis ( 3 , 4 ).…”

“…An altered immune response in patients with uncontrolled diabetes mellitus is recognized to lead to an increased risk of multiple types of infections ( 5 ). However, only three reported cases of associated purulent pericarditis have so far been published based on our review of the pertinent literature ( 3 , 4 ). We herein report an unusual case of pericarditis caused by Salmonella enterica subspecies arizona ( S. enterica subsp.…”