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Purulent pericarditis misdiagnosed as septic shock
E L Arsura1, W B Kilgore, E Strategos
1Department of Internal Medicine, Kern Medical Center, Bakersfield, Calif, USA.
Southern Medical Journal
|March 27, 1999
Summary
Purulent pericarditis can be misdiagnosed as septic shock, even without classic symptoms. Early consideration of this rare condition is crucial for accurate diagnosis and patient management.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Septic shock is a common diagnosis, often made presumptively in febrile, hypotensive patients.
- Purulent pericarditis, a rare condition, presents with fever and hypotension but often lacks classic signs.
- Classic signs of pericardial tamponade are absent in up to 50% of purulent pericarditis cases.
Observation:
- Four patients with purulent pericarditis and tamponade were initially misdiagnosed as septic shock.
- These cases constituted 13% of septic shock admissions over a 3-month period.
- Patients presented with subtle or absent classic tamponade findings.
Findings:
- All patients were bacteremic.
- Hemodynamic data, including elevated systemic vascular resistance, low cardiac output, and normal pulmonary artery occlusion pressure, were key diagnostic indicators.
- Subtle or absent classic signs of pericardial tamponade were noted.
Implications:
- Purulent pericarditis should be considered in patients diagnosed with septic shock, especially when classic signs are absent.
- A high index of suspicion is necessary for the timely diagnosis and management of purulent pericarditis.
- Misdiagnosis can lead to delayed treatment and potentially worse outcomes for patients with purulent pericarditis.