Primary pericardial abscess caused by Staphylococcus aureus infection without a predisposing condition

Area of Science:

• Cardiology
• Infectious Diseases
• Pathology

Background:

• Pericardial abscess (PA) is a rare and severe condition.
• It can present without obvious signs of infection, complicating early diagnosis.
• Staphylococcus aureus is a potential causative agent.

Observation:

• A 75-year-old man presented with fever and dyspnea, later found to have a lesion near the left ventricle and pericardial effusion.
• Initial blood cultures were negative, but fluid drained from the pericardial effusion grew methicillin-sensitive Staphylococcus aureus.
• Histological examination revealed neutrophil infiltration in the pericardium and myocardium.

Findings:

• This case highlights that purulent pericarditis with a pericardial abscess can occur without detectable bacteremia.
• Despite drainage and antibiotics, the patient developed constrictive pericarditis and multi-organ failure, leading to death.

Implications:

• Emphasizes the need for considering PA even with negative blood cultures.
• Underscores the importance of early and aggressive management, including source control and appropriate antimicrobial therapy.
• Suggests that improved diagnostic strategies and timely intervention may be key to better outcomes in pericardial abscess.