The changed spectrum of purulent pericarditis

Klacsmann, Peter G.; Bulkley, Bernadine H.; Hutchins, Grover M.

doi:10.1016/0002-9343(77)90150-4

Cited by 236 publications

(92 citation statements)

References 32 publications

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“…In the uremia with infection group, some bacteria or virus might be concerned with the UPE, because antibiotics were usually effective in the treatment of it (Crossley et al 1973;Berger et al 1975; Klacsmann et al 1977). The UPE in the uremia with other diseases group might be related in some way to the states of underlying diseases.…”

Section: Upe and Renal Functionmentioning

confidence: 99%

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Matsumoto

Murata

Sato

et al. 1980

Tohoku J. Exp. Med.

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Section: Upe and Renal Functionmentioning

confidence: 99%

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Matsumoto

Murata

Sato

et al. 1980

Tohoku J. Exp. Med.

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“…A Gram stain showed many leukocytes and a few intracellular gramnegative diplococci. The fluid consisted of 7,577 red blood cells/ml, 93,800 WBC/ml (91% neutrophils), pH 7.54, glucose 200 mg/liter, protein 56 gmhiter, and The patient responded well to 2 weeks of intravenous penicillin G therapy (24 million unitdday). The prednisone dosage was tapered rapidly in the hospital and totally discontinued over the following month, with no evidence of a lupus flare.…”

mentioning

confidence: 99%

“…Important features pointing to an infectious etiology were the marked leukocytosis, recurrent rigors, and persistent monarthritis that did not respond to high-dose steroid therapy (5,6). Purulent pericarditis is rare, but may arise directly from a pulmonary source, from hematogenous dissemination, or from iatrogenic introduction into the pericardial space (7)(8)(9)(10). Staphylococci and streptococci account for the majority of cases, although gram-negative infections have increased in frequency since the introduction of antibiotics (7,9).…”

mentioning

confidence: 99%

“…Purulent pericarditis is rare, but may arise directly from a pulmonary source, from hematogenous dissemination, or from iatrogenic introduction into the pericardial space (7)(8)(9)(10). Staphylococci and streptococci account for the majority of cases, although gram-negative infections have increased in frequency since the introduction of antibiotics (7,9). The presence of prior sterile pericardial effusions, such as in uremia or associated connective tissue disease, is frequently a predisposing factor (7,8,11).…”

mentioning

confidence: 99%

“…Staphylococci and streptococci account for the majority of cases, although gram-negative infections have increased in frequency since the introduction of antibiotics (7,9). The presence of prior sterile pericardial effusions, such as in uremia or associated connective tissue disease, is frequently a predisposing factor (7,8,11).…”

mentioning

confidence: 99%

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Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus

Coe

Hamer

Levy

et al. 1990

Arthritis & Rheumatism

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Pericarditis is one of the most frequent manifestations of systemic lupus erythematosus; however, purulent pericarditis and tamponade are rare. We describe a patient with systemic lupus erythematosus and culture-proven gonococcal arthritis who developed purulent pericarditis with intracellular gram-negative diplococci. Evidence of tamponade was seen on echocardiography. There has not been a reported case of Nekseriu gonorrhoem in pericardial fluid or tissue since the introduction of antibiotics.Pericarditis in patients with systemic lupus erythematosus (SLE) is a frequent finding at the time of clinical presentation or upon autopsy; however, both purulent pericarditis and tamponade are rare (1-3). We recently saw a patient with SLE and gonococcal arthritis whose presentation mimicked a lupus flare and whose course was complicated by purulent pericarditis with echocardiographic evidence of tamponade. Her case is reported herein.Case report. The patient, a 35-year-old woman with SLE, developed fever, migratory polyarthralgias, and left-sided pleuritic chest pain in July 1988. On the first day of the illness, she had an acute onset of pain, swelling, and erythema of the small joints of both hands and the left wrist, accompanied by a small, painless, erythematous vesicle on the left thumb. Two days later, she developed fever, pleuritic chest pain, and mild dyspnea. By the fourth day, she was ill enough to seek medical attention. Although her white blood cell (WBC) count was elevated on initial presentation (20 x 109/liter), a lupus flare was presumed, and she was started on a regimen of prednisone, 60 mg/ day. One week later, the chest pain had subsided and the polyarthralgias had cleared; however, the left wrist became swollen and tender. Prednisone was increased to 80 mg/day. During the next week, the wrist pain worsened, and was associated with fever as high as 40°C and recurrent rigors. The patient was referred to the Washington Hospital Center and was admitted.The medical history revealed that 8 years prior to this time, the patient had presented with malar rash, alopecia, arthralgias, serositis, and anemia. Fluorescent antinuclear antibody was positive. The diagnosis of SLE was made, and steroid therapy was initiated. She responded well, and steroids were tapered over the next year and a half. She was well during this time, occasionally using ibuprofen for arthralgias. The remainder of the medical history was remarkable for a partial hysterectomy, which had been performed within the year prior to admission, and a remote history of pelvic inflammatory disease. Four weeks prior to admission, she noted a vaginal discharge.On admission, she was acutely ill with a temperature of 40.0"C and a pulse rate of 12Olminute. The left wrist was exquisitely tender, warm, and swollen. There was tenderness along flexor tendon surfaces proximal to the left wrist and erythema on the anterolateral left ankle. A shallow ulcer (0.5 cm) was ob-

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Microbiology of acute purulent pericarditis. A 12-year experience in a military hospital

Brook¹

1996

Archives of Internal Medicine

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The changed spectrum of purulent pericarditis

Cited by 236 publications

References 32 publications

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus

Microbiology of acute purulent pericarditis. A 12-year experience in a military hospital

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