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Primary bacterial pericarditis
Tine Keersmaekers1, Stephen R E Elshot, Paul T Sergeant
1Department of Internal Medicine, Gasthuisberg University Hospital, Leuven, Belgium. tkeersmaekers@hotmail.com
Abstract:
Purulent pericarditis is rarely the primary site of bacterial infection. It is usually a complication of an infection originating elsewhere in the body, arising by contiguous spread or haematogenous dissemination.This paper, however, describes a previously healthy young man, who developed a purulent streptococcal pericarditis with no localizable primary focus. Although many possibilities were investigated, the entry site of the pericarditis remains unknown. The incidence of purulent pericarditis has decreased considerably since the antibiotic era. It is typically an acute and potentially lethal disease, necessitating rapid diagnosis and adequate therapy to improve prognosis. Standard treatment combines appropriate antibiotic therapy with surgical drainage. However, the exact timing and type of surgery is still under discussion. Our patient was treated with antibiotics, subxiphoidal tube drainage of the pericardial fluid and intrapericardial thrombolysis. After three weeks, he developed tamponade, requiring partial pericardiectomy. He recovered completely and resumed his normal activities after a two-month hospitalisation.
Insights
This case study highlights a rare instance of primary purulent streptococcal pericarditis in a young man. Despite extensive investigation, the infection
Area of Science:
- Infectious Diseases
- Cardiology
- Internal Medicine
Background:
- Purulent pericarditis is typically a secondary infection, complicating other bacterial sources.
- Its incidence has declined due to antibiotics but remains a severe, potentially fatal condition.
- Standard management involves antibiotics and surgical drainage, though optimal surgical approach is debated.
Observation:
- A previously healthy young male presented with purulent streptococcal pericarditis.
- No identifiable primary infection site was found despite thorough investigation.
- Initial treatment included antibiotics, subxiphoid drainage, and thrombolysis.
Findings:
- The patient developed cardiac tamponade after three weeks, necessitating a partial pericardiectomy.
- Complete recovery was achieved after a two-month hospitalization.
- This case underscores the possibility of idiopathic purulent pericarditis.
Implications:
- Highlights the diagnostic challenge of purulent pericarditis with unknown primary focus.
- Suggests a need for vigilance and tailored management in seemingly idiopathic cases.
- Reinforces the critical role of timely intervention, including surgical options, for favorable outcomes.