Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with...

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Purulent pericarditis is a severe infection of the pericardium with a high mortality rate.
• Tuberculous lymphadenitis can lead to complex thoracic infections.
• Multimicrobial infections involving fungi, bacteria, and mycobacteria are exceptionally rare.

Purpose of the Study:

• To report a unique case of purulent pericarditis caused by a polymicrobial infection including Mycobacterium tuberculosis.
• To describe the probable infectious pathway in a previously healthy adolescent.
• To highlight the successful management of this rare condition.

Main Methods:

• Case report of a 17-year-old male with purulent pericarditis.
• Identification of causative pathogens: Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis.
• Diagnostic workup including imaging and microbiological cultures.
• Treatment involved antibiotics, antifungals, antituberculous therapy, and pericardiectomy.

Main Results:

• The patient presented with purulent pericarditis secondary to mediastinal tuberculous lymphadenitis.
• A bronchomediastinal lymph node-pericardial fistula was identified as the likely route of infection.
• The polymicrobial infection was successfully eradicated.
• Clinical improvement was achieved post-treatment.

Conclusions:

• This case underscores the possibility of rare, complex polymicrobial pericarditis, even in immunocompetent individuals.
• Early diagnosis and aggressive multimodal treatment, including antimicrobial therapy and surgical intervention, are crucial for favorable outcomes.
• Tuberculosis should be considered in the differential diagnosis of purulent pericarditis, especially in endemic areas.