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Staphylococcal pericarditis in a chronic renal failure patient
N P Singh1, Anupam Prakash, Aman Makhija
1Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. nanu_singh@yahoo.com
Renal Failure
|June 14, 2003
Summary
This case study highlights acute primary purulent pericarditis in a patient with end-stage renal disease. Prompt diagnosis and treatment, including antibiotics and drainage, were crucial for recovery.
Area of Science:
- Nephrology
- Infectious Diseases
- Cardiology
Background:
- A 34-year-old female with end-stage renal disease (ESRD) presented with severe metabolic acidosis, uremic encephalopathy, pericarditis, and anemia after acute gastroenteritis.
- Initial management included intensive hemodialysis, leading to improvement and initiation of maintenance heparin-free hemodialysis.
Observation:
- The patient subsequently developed fever, chills, rigors, toxicity, severe orthopnea, and a significant pulsus paradoxus (36 mmHg).
- Echocardiography indicated cardiac tamponade, and aspiration yielded purulent fluid with Staphylococcus aureus.
- Thoracic CT confirmed pericardial effusion, leading to a diagnosis of acute primary purulent pericarditis in the absence of other identifiable septic sources.
Findings:
- Treatment involved parenteral antibiotics (ceftriaxone, metronidazole, vancomycin), initial pericardial drainage, and continued maintenance hemodialysis.
- The patient's condition improved with resolution of toxemia, decreased pulsus paradoxus, and subsided fever.
Implications:
- This case underscores the importance of considering primary purulent pericarditis in ESRD patients presenting with cardiac tamponade and sepsis.
- Aggressive medical and procedural management is vital for favorable outcomes in such complex cases.
- The successful management highlights the interplay between nephrology, infectious disease, and cardiology in treating critically ill patients.