Propionibacterium acnes: A Treatable Cause of Constrictive Pericarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Infective pericarditis is often caused by common pathogens.
• Propionibacterium acnes (P. acnes) is a rare cause of pericarditis, typically associated with surgical procedures or indwelling devices.
• Idiopathic pericardial effusion can have diverse underlying causes, necessitating a broad differential diagnosis.

Purpose of the Study:

• To report a case of P. acnes-induced infective pericarditis in an immunocompetent, non-surgical patient.
• To highlight the significance of P. acnes in idiopathic pericardial effusion and effusive constrictive disease.
• To review the diagnostic and therapeutic challenges associated with P. acnes pericarditis.

Main Methods:

• Case presentation of a 61-year-old male with osteoarthritis.
• Diagnosis of pericardial and pleural effusions with P. acnes isolation.
• Treatment with oral amoxicillin followed by intravenous Penicillin G.
• Echocardiographic assessment for constrictive physiology.

Main Results:

• P. acnes was isolated from pericardial and pleural fluids.
• Initial oral antibiotic treatment led to recurrence of effusions and constrictive physiology.
• Intravenous Penicillin G resulted in symptomatic improvement, effusion resolution, and no evidence of constrictive pericarditis at follow-up.

Conclusions:

• P. acnes should be considered in cases of idiopathic pericardial effusion, even in immunocompetent, non-surgical patients.
• Early and appropriate antibiotic therapy, particularly intravenous Penicillin G, is crucial for managing P. acnes pericarditis.
• Timely treatment can prevent the progression to constrictive pericarditis.