Successful treatment of community-acquired methicillin-resistant Staphylococcus aureus purulent myopericarditis

Abstract

A previously healthy 48-year-old active duty man, who had been treated for an elbow abscess 3 weeks earlier, presented to an emergency department in Bahrain with tachycardia, pericardial friction rub and jugular venous distention. Cardiac tamponade was confirmed on transthoracic echocardiogram and he was taken for emergent pericardiocentesis. Pericardial fluid cultures grew community-acquired methicillin-resistant Despite ongoing treatment with intravenous vancomycin, he developed a recurrent fibrinous pericardial effusion and constrictive pericarditis requiring pericardiectomy. Though he initially did well postoperatively, he developed drug reaction with eosinophilia and systemic symptoms syndrome in response to vancomycin. He was transitioned to ceftaroline and started on high-dose steroids. He recovered during a week-long admission and was discharged home. Several weeks later at follow-up he was doing well and had resumed moderate intensity exercise.

Methicillin-resistant Staphylococcus aureus pericarditis causing cardiac tamponade

“…Mechanisms of disease dissemination include contiguous extension of intrathoracic processes, hematogenous spread, penetrating chest wall injury, surgical wounds, esophageal rupture with fistula formation, retropharygeal abscess, and seeding from hepatic or subdiaphragmatic abscess. Previous cases of purulent MRSA pericarditis describe patients with ages 19–60 years, and with predisposing conditions including pseudoaneurysm, obesity, diabetes mellitus, cocaine use, malignancy and DRESS syndrome [[1], [2], [3], [4], [5], [6]]. Our patient was a diabetic with history of malignancy.…”

“…Pericarditis due to MRSA is extremely rare, especially in the antimicrobial era and in the absence of prior surgical interventions. Of note, only 6 cases have been reported in the literature around the world [[1], [2], [3], [4], [5], [6]]. This condition carries significant morbidity and mortality, with the mortality rate reaching up to 60%, mostly because of cardiac tamponade, toxicity and constriction.…”

“…This condition carries significant morbidity and mortality, with the mortality rate reaching up to 60%, mostly because of cardiac tamponade, toxicity and constriction. It is thought that up to 42–77% of patients develop cardiac tamponade [[1], [2], [3], [4], [5], [6]].…”

A Rare Case of MRSA Pericarditis with Expanding, Purulent Pericardial Effusion Leading to Uremic Kidney Failure from a Right, Necrotic Toe

“…This organism colonizes the nasopharynx, perineum, and skin, and it can migrate into the circulatory system and lead to hematogenous spread if the cutaneous barrier is disrupted or damaged. The diagnosis of purulent pericarditis from MRSA is extremely rare, with only a few case reports thus far [2][3][4][5][6][7][8]. However, the mortality rate for untreated patients can approach 100% but decreases to 40% in those patients who are appropriately treated with antibiotics and source control [9].…”