Primary pericardial abscess caused by Staphylococcus aureus infection without a predisposing condition

Abstract

Pericardial abscess (PA) is a rare but serious life-threatening illness. Since the advent of antibiotic therapy, the incidence of PA has decreased, while the etiologic agents have changed from predominantly pneumococcus and streptococcal species to staphylococcus, anaerobes, and fungus [1]. Nowadays, PA is observed as a secondary complication of immunosuppression in hosts, chronic inflammation, drug users, or following trauma. We report the case of a patient with primary PA induced by Staphylococcus aureus infection without bacteremia, which developed to constrictive pericarditis. Case reportA 75-year-old man presented to our hospital with a lowgrade fever and a one-month history of worsening dyspnea. His medical history was myelodysplastic syndrome (MDS) without excess blasts, indicating good prognosis (international prognostic scoring system: scored as very low risk). On physical examination, the blood pressure was 113/61 mmHg, the pulse rate 53 beats per minute, and the temperature 37.3 C. Laboratory tests revealed a white blood cell count of 10,300/ mL (neutrophils, 81%), hemoglobin 7.5 g/dL, C-reactive protein 17.84 mg/dL, creatine kinase 69 U/L, creatine kinase myocardial band 16 U/L, and troponin T 0.038 ng/mL, which indicated inflammation, infection, and refractory anemia of MDS, but no sign of myocardial injury. His chest radiograph showed cardiomegaly without congestion. A twelve-lead electrocardiogram showed normal sinus rhythm and ST elevation in leads I, II,

Localized massive staphylococcal pericardial abscess with atypical presentation

“…Risk factors include diabetes mellitus, other active infection (eg, endocarditis or pneumonia), immunosuppression, and having a preexisting pericardial effusion [ 2 ]. PA occurs in patients with immunosuppression as secondary complication, although since the advent of antibiotic therapy, the incidence of PA has decreased [ 3 ]. It usually presents as generalized involvement of the pericardium, but here we report a case with localized massive staphylococcal pericardial abscess [ 4 , 5 ].…”