A rare case of purulent pericarditis secondary to subdiaphragmatic abscess

ABSTRACT

@#Subdiaphragmatic abscess is the accumulation of pus in the space between the diaphragm and the transverse colon and its mesentery.[1] Subdiaphragmatic abscess is clinically characterized by fever and local pain. Its clinical manifestations are often vague and diverse, and its symptoms and signs together constitute thoracoabdominal syndrome, leading to delayed diagnosis and a high incidence rate and mortality.[2]Subdiaphragmatic abscess is often secondary to acute peritonitis or remote infection with hematogenous dissemination. The bacteriological characteristics of these abscesses include aerobic and facultative bacteria, such as Escherichia coli, group D Enterococcus and Staphylococcus aureus, as well as less common anaerobic organisms, such as Bacteroides.[3] In 1938, Ochsner and DeBakey recognized chest complications of subdiaphragmatic abscesses, including empyema, bronchial fistula, and pericarditis, in their classic review of subdiaphragmatic abscesses. Because of the structural characteristics of the diaphragm, there are fewer complications of diaphragm perforation.[4] Especially now, with the use of antibiotics, these complications have become more rare. Here, we report a case of purulent pericarditis caused by Klebsiella pneumonia, secondary to subdiaphragmatic abscess extending through the diaphragm.