Acute Purulent Staphylococcal Pericarditis with Cardiac Tamponade in a Hemodialysis Patient / 대한신장학회지

ABSTRACT

Purulent pericarditis is a rare disease in both end-stage renal disease (ESRD) patients and the general population. We report herein a case of acute purulent staphylococcal pericarditis with cardiac tamponade managed by intravenous antibiotics and pericardiocentesis with drainage. A 54-year-old man with ESRD, who had been on hemodialysis (HD) for the previous six months, was admitted to the hospital because of fever. He had a history of a recent episode of staphylococcal bacteremia associated with venography for arteriovenous fistula (AVF) malfunction. On the sixth day after admission, severe intradialytic hypotension arose during HD. Echocardiography showed a large pericardial effusion with hemodynamic significance. Emergency pericardiocentesis with drainage was performed. Acute purulent staphylococcal pericarditis with cardiac tamponade was diagnosed and intravenous vancomycin was administered for four weeks. On the 23rd day, the patient was discharged from the hospital after the drainage catheter's removal. Ten days after discharge, however, he was re-admitted because of dyspnea on exertion. Eventually, the patient expired because of heart failure caused by progressive constrictive pericarditis. We suggest that acute purulent pericarditis should be considered in dialysis patients who develop fever and severe hypotension during HD, especially after known staphylococcal infections.