Purulent Pericarditis in a Dog Administered Immune-Suppressing Drugs

Abstract

ABSTRACT. A 5-year-old castrated mongrel dog was brought to our hospital with anorexia and vomiting. Laboratory testing revealed immune-mediated hemolytic anemia (IMHA), and so treatment was initiated with multiple immune-suppressing drugs, achieving partial remission from IMHA. However, cardiac tamponade due to purulent pericarditis was identified as a secondary disease. Culture of pericardial fluid yielded numerous Candida albicans and multidrug-resistant Acinetobacter sp. Pericardiocentesis was performed, and the condition of the dog improved. However, the dog died the next day. KEY WORDS: cardiac tamponade, immune-mediated hemolytic anemia, purulent pericarditis.J. Vet. Med. Sci. 71(5): 669-672, 2009 Pericardial effusion is found in 7% of canine cardiac diseases incidentally during echocardiography or as a result of clinical presentation associated with cardiac tamponade [13]. When pericardial effusion increases, intrapericardial pressure rises above the diastolic intracardiac pressure and results in cardiac tamponade. In cardiac tamponade, cardiac output is reduced, and this results in hypovolemia in peripheral tissue and ultimately cardiogenic shock [6,13,14]. Pericardial effusion is mostly commonly the result of a tumor or unknown cause (about 90% of cases), and other causes, such as infection or cardiac rupture, are rare [6,12]. Purulent pericarditis has been described in association with coccidioidomycosis, aspergillosis, actinomycosis, nocardiosis and tuberculosis [2,4,6,13,14]. Purulent pericarditis is also occasionally associated with biting and intrapericardial foreign body presentation [5]. The treatment for purulent pericarditis is removal of pericardial fluid by pericardiocentesis and administration of a suitable antibiotic. However, if the dog is stable enough for surgery, pericardectomy is recommended [6,13,14]. The present report describes a case of cardiac tamponade due to purulent pericarditis associated with Candida albicans and Acinetobacter sp. in a dog administered immunosuppressive drugs for treatment of immune-mediated hemolytic anemia (IMHA).A 5-year-old neutered male mongrel dog was brought to our hospital with vomiting, depression and anorexia. On clinical examination, the dog was found to be obese with slight pallor of the visible mucous membranes. No cardiac murmur was evident. Blood testing revealed anemia (packed cell volume 18%; reference range 33 to 55%) and increased levels of alkaline phosphatase (1628 U/l; reference range 47 to 254 U/l) and total bilirubin (0.8 mg/dl; reference range 0.1 to 0.5 mg/dl). No autoagglutination of blood was observed. Anisocytosis and polychromasia with a moderate number of spherocytes were observed. A large number of reticulocytes was also evident. A direct Coombs' test yielded positive results. Abdominal radiography showed severe splenomegaly, but ultrasonography of the spleen showed normal results.The clinical diagnosis for this dog was IMHA, so administration of prednisolone (2 mg/kg, once daily) was initiated. However, the packed cell vol...

Fungal myocarditis and pericardial effusion secondary to Inonotus tropicalis (phylum Basidiomycota) in a dog

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Oral Cyclosporine Treatment in Dogs: A Review of the Literature

“…Adverse effects common to most other immunosuppressive agents, but not reported with cyclosporine, include myelosuppression and neutropenia. Concurrent infections documented in patients receiving cyclosporine treatment include bacterial infections of the respiratory and urinary tracts, pyelonephritis, pyometra, purulent pericarditis, septic arthritis, toxoplasmosis, neosporosis, demodicosis, and pyoderma . Malignancies, including lymphoma, have occurred in conjunction with concurrent use of cyclosporine .…”

A case of spontaneous purulent granulomatous pericarditis in a beagle

“…Spontaneous purulent pericarditis is an uncommon disease in dogs 1 , 2 , 3 . Purulent pericarditis is generally caused by pyogenic bacterial or fungus infections 3 , 4 , 5 , 6 . These infections are usually the result of hematogenous infection or extension of local infections, such as endocarditis, pleuritis or pulmonary infection, to the myocardial tissue 3 , 5 , 7 .…”

“…These infections are usually the result of hematogenous infection or extension of local infections, such as endocarditis, pleuritis or pulmonary infection, to the myocardial tissue 3 , 5 , 7 . Occasionally, trauma such as bites or intrapericardial foreign bodies are also associated with the occurrence of purulent pericarditis 3 , 6 , 8 . Furthermore, spontaneous vascular changes, such as idiopathic canine polyarteritis or beagle pain syndrome, could be associated with the occurrence of pericarditis 9 .…”

“…Purulent pericarditis is a relatively rare form of heart disease in dogs 1 , 2 , 3 . Purulent pericarditis is most commonly caused by a foreign body such as food like bone by esophageal perforation, penetrating wounds, systemic infections, or extension from local infections like endocarditis, pleuritis, or pulmonary disease 3 , 4 , 5 , 6 , 7 , 8 . In cases of purulent pericarditis, the purulent exudate, which is often mixed with fibrin, fills the pericardial space, and the entire epicardium becomes covered with coagulum 4 , 5 .…”