Streptococcus Pneumoniae Purulent Pericarditis

ABSTRACT

Background Bacterial pericarditis represents < 1 % of all cases of pericarditis in the United States. Most cases of bacterial pericarditis are from contiguous spread from underlying pneumonia or mediastinitis. We present a case of pneumococcal pericarditis in a patient with untreated pneumonia. Case A 54-year-old male with a past medical history of recent COVID-19 pneumonia presented with worsening dyspnea for the past 3 weeks. Vitals were T 99.3, BP 122/93, HR 159 BPM, O2 sat 94% on 3 L NC. ECG demonstrated atrial flutter with 21 block. CT scan demonstrated a pericardial effusion and bilateral pleural effusions. Decision-making In the ED, he became hypotensive and bedside echo demonstrated large pericardial effusion with RV collapse. Emergent pericardiocentesis produced 750 cc of purulent fluid. Streptococcus pneumoniae was isolated from the initial fluid aspirate. Right thoracostomy tube was placed with pleural fluid gram stain and culture without bacterial growth. Due to continued purulent drainage from the pericardial drain, repeat CT scan demonstrated persistent pericardial effusion and loculated right sided pleural effusion. He underwent video-assisted thoracoscopic surgery with pericardial wash out and window. He improved and was discharged with 6 weeks of Ceftriaxone. Conclusion Purulent pericarditis is typically a fulminant disease associated with high mortality and rapid progression. Prompt identification and management is critical for patient survival. [Formula presented]Copyright © 2023 American College of Cardiology Foundation