Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report

Abstract

BackgroundAcute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions.Case presentationA 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery.ConclusionsAcute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.

The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding

“…Secondary pericarditis caused by S. anginosus has been reported four times since 2000, twice as a complication after S. intermedius infections. The primary purulent pericarditis is extremely rare, including one case in which S. anginosus culture grew confirmed and another caused by S. intermedius ( Khan et al, 2018 ; Beom et al, 2021 ).…”

Great Toe Infection Leading to Methicillin-Sensitive Staphylococcus aureus Pericarditis and Tamponade

“…An echocardiogram is the most sensitive test and shows the presence of fluid in the pericardial cavity in almost all patients. However, the limitations of echocardiography are that it fails to differentiate purulent fluid collections from other causes of acute pericarditis [ 4 ]. Therefore, once the presence of a pericardial effusion has been identified, and there is suspicion of purulent pericarditis, a percutaneous pericardiocentesis should be quickly performed.…”

“…The combination of vancomycin, fluoroquinolone, and third-generation cephalosporin should be included for critically ill patients [ 4 , 7 ]. After obtaining the pericardial fluid, samples should be sent for urgent microbiological staining, followed by culture sensitivities [ 16 ].…”

“…Bacterial pericarditis is less prevalent in the present antibiotic era and the overwhelming majority of cases occur in those who are immunocompromised or in individuals with an underlying disease of the pericardium [ 4 , 5 ]. This disease process occurs via many mechanisms including hematogenous dissemination, contiguous spread from an intrathoracic, myocardial, or subdiaphragmatic focus, or direct infection during trauma, thoracic surgery, or catheter drainage [ 6 ].…”

Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema

“…Acute bacterial pericarditis is rarely encountered in the modern antibiotic era [1]. Purulent pericarditis is a very serious form of bacterial pericarditis and is defined by the presence of frank pus in the pericardium [2]. It carries a high mortality rate as it can rapidly progress to tamponade and death.…”