Acute Purulent Pericarditis Presenting as Cardiac Tamponade: An Unusual Complication of Pneumococcal Pneumonia in the Postantibiotic Era

1St. Joseph Mercy Hospital, Ann Arbor, Ml
2St. Joseph Mercy Hospital, Ann Arbor, Ml
3St. Joseph Mercy Hospital, Ann Arbor, Ml
4St. Joseph Mercy Hospital, Ann Arbor, Ml

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 286

Case Presentation:

A 56‐year‐old female with a history of arthritis initially presented to the emergency room (ER) with progressive weakness, dyspnea, and chest pain. She also reported recent fever and cough, which had resolved spontaneously. In the ER, she was hypothermic, tachypneic. and hypotensive. Her electrocardiogram revealed 1‐mm ST elevations in the inferior leads. Her labs revealed a mildly elevated troponin, profound leukocytosis, and an elevated creatinine. Her chest x‐ray showed a right‐sided infiltrate. Because of hemodynamic instability, she was resuscitated with normal saline and dopamine. She was transported to a tertiary‐center catheterization lab to receive an urgent heart catheterization for a presumed myocardial infarction. In the catheterization lab, the patient was profoundly hypotensive A stat echocardiogram displayed a circumferential pericardial effusion and right atrial collapse. A pericardiocentesis was performed, and 260 mL of purulent fluid was aspirated. A “pig tail” catheter was placed for drainage and empiric antibiotic coverage was initiated. Post procedure her vitals improved, and the dopamine was discontinued. The pericardial fluid and blood cultures grew Streptococcus pneumonia. Her symptoms continued to improve, but she ultimately required a pericardial window for reaccumulation of pericardial fluid.

Discussion:

The pattern of the presentalion of purulent pericarditis has changed. Prior to the advent of antibiotics, purulent pericarditis due to pneumococcus was common. However, there have been few reported cases of purulent pericarditis complicated by cardiac tamponade. The acute illness is typically characterized by high fever, tachycardia, chest pain, and cough. When the diagnosis is delayed, mortality can be as high as 30%. Our case is an example of a severe complication of acute purulent pericarditis due to pneumococcal pneumonia.

Conclusions:

With the introduction of penicillin, pneumococcal pericarditis has become uncommon, especially in patients without chronic conditions such as uremia, diabetes, thoracic surgery, malignancy, connective tissue disease, or HIV. Pneumococcal pneumonia may extend to purulent pericarditis from adjacent mediastinal structures or, more rarely, by hematogenous seeding. Untreated, purulent pericarditis is fatal, but proper antibiotic therapy, early diagnosis, and drainage of the pericardial fluid can lead to a good outcome.

Author Disclosure:

A. Khanna, none; A. Tiwari, none; R. Daniel, none; M. Otto, none.

To cite this abstract:

Khanna A, Tiwari A, Daniel R, Otto M. Acute Purulent Pericarditis Presenting as Cardiac Tamponade: An Unusual Complication of Pneumococcal Pneumonia in the Postantibiotic Era. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 286. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/acute-purulent-pericarditis-presenting-as-cardiac-tamponade-an-unusual-complication-of-pneumococcal-pneumonia-in-the-postantibiotic-era/. Accessed August 24, 2019.

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