Purulent Pericarditis

Parikh, Shailja V.; Memon, Nada; Echols, Melvin R.; Shah, Jessica; McGuire, Darren K.; Keeley, Ellen C.

doi:10.1097/md.0b013e318194432b

Cited by 103 publications

(65 citation statements)

References 82 publications

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“…Signs of tamponade may not be clinically apparent until shock ensues, making a high index of suspicion in the setting of pneumonia and minor hemodynamic derangements important in treatment. Of particular note in our patient was his extremely elevated WBC count of 39 000 cells/ml, which seems to follow the trend in patients with gram-positive cocci and who are above the age of 50 years [6,7]. Long-term consequences include constriction.…”

Section: Discussionsupporting

confidence: 57%

Massive Purulent Pericardial Effusion Presenting as Atrial Fibrillation with Rapid Rate: Case Report and Review of the Literature

Kathrotia

Hindupur

2014

Am J Case Rep

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Patient: Male, 59Final Diagnosis: Pleural and pericardial effusion from a Streptococcus pneumoniaSymptoms: Chest pain • chills • cough • fever • shortness of breathMedication: —Clinical Procedure: Pericardiocentesis • pericardial windowSpecialty: CardiologyObjective:Rare diseaseBackground:Although pericardial effusion with afib is not rare, the combination of purulent pericardial effusion presenting as afib is not a common occurrence particularly in the developing world. The more common symptoms associated with purulent pericardial effusion are fever, dyspenia, and tachycardia. Without prompt recognition followed by antibiotics and surgical drainage, tamponade, and shock can potentially lead to death.Case Report:A 59-year-old male was transferred to our hospital for evaluation of afib with rapid rate associated with cough and dyspenia. He reported fevers, chills, cough and sputum for 1 week. Complaints included chest pain with relief upon lying down. Patient was afebrile with a pulse of 101 and blood pressure of 119/89. WBC 39,200 cells/ml. Chest X-RAY showed right lower lobe pneumonia and EKG revealed afib, rapid ventricular response, and secondary ST changes inferolaterally. Pericardial effusion and thickened pericardium were eveident on echo. Patient was treated for community acquired pneumonia, along with heparin and IV amiodarone. Both sputum cultures and pericardiocentesis revealed S. Pneumoniae. Cardioversion reestablished sinus mechanism. Intially pericardial effusion resolved, but later reaccumulated at which point it was decided to perform a subxiphoid pericardial window. Follow up showed no effusion and patient was asymptomatic.Conclusions:Purulent pericardial effusion with atrial fibrillation and rapid ventricular rate needs to be recognized promptly. Because friction fub and chest pain are not present in every case, prompt management in the setting of pneumonia and minor hemodynamic derangements can aid in the treatment of this potentially life threating disease.

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Section: Discussionsupporting

confidence: 57%

Massive Purulent Pericardial Effusion Presenting as Atrial Fibrillation with Rapid Rate: Case Report and Review of the Literature

Kathrotia

Hindupur

2014

Am J Case Rep

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“…Although Streptococcus pneumoniae would not be rare as the cause of infective pericarditis, which was the secondary predominant microorganism responsible for purulent pericarditis following Staphylococcus aureus in a recent review [5], there, were some atypical findings in the present case compared with previous reports. First, the patient did not have severe general condition.…”

Section: Discussioncontrasting

confidence: 47%

A Case of Slowly Progressive Purulent Pericarditis in Elderly Healthy Woman

Kodani

Tadera²,

Ibuki³

et al. 2014

J Gen Pract

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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.

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“…AureusnoConservativeyesAkashi 2000 [5]61/femaleChemotherapyGroup B StreptococcusnoSurgicalyesSchneider 2004 [6]60/femaleNoneS. EnteritidisnoSurgicalnoPatel 2006 [7]20/maleNoneMRSAnoSurgicalyesSaito 2009 [8]66/femaleNoneMRSAnoConservativenoParikh 2009 [9]46/femaleIV drug, hep C, diabetes S. agalactiae , C. glabrata NRConservativeyesNagano 2010 [10]76/femaleNoneS. PneumoniaeNRSurgicalyesSayah 2013 [11]70/femaleLung transplantScedosporiumNRConservativeno…”

Section: Discussionmentioning

confidence: 99%