Propionibacter acnes complicating HIV-associated tuberculous pericardial effusion in Cameroon

Large pericardial effusions are common in sub-Saharan Africa. They are most often caused by tuberculosis and are frequently associated with HIV infection. We report on a case of massive pericardial effusion in a 32-year-old HIV-positive male with smear-positive pulmonary tuberculosis. This was found to be colonised by Propionibacter acnes, which is normally found in anaerobic skin flora. Despite management, including appropriate antibiotic treatment based on culture and sensitivity, the patient died several weeks later. While cases of bacterial pericarditis have been described previously, this is the first report of Propionibacter isolated from a pericardial effusion. This case suggests that superinfection could have occurred iatrogenically as a result of pericardiocentesis three weeks prior to admission. We feel that proper sterile techniques, including generous use of povidone-iodine, which is readily available in resource-poor settings, may improve clinical outcomes in immunosuppressed patients undergoing invasive procedures.