Community-associated Methicillin-resistant Staphylococcus aureus pericarditis in an immunocompetent patient

Area of Science:

• Infectious Diseases
• Cardiology
• Critical Care Medicine

Background:

• Pericarditis caused by Methicillin-resistant Staphylococcus aureus (MRSA) is a rare infection.
• It is often observed in patients with chronic kidney disease, immunosuppression, or prior pericardial disease.
• The condition can manifest acutely, leading to septic shock or obstructive shock from pericardial tamponade, or present indolently.

Observation:

• A 57-year-old male with a history of smoking and alcohol use presented with dyspnea and cough.
• He was diagnosed with disseminated MRSA infection causing pericarditis and pericardial tamponade.
• Urgent pericardiocentesis drained 1.1 liters of purulent fluid positive for MRSA, which was also found in blood and pleural fluid.

Findings:

• The patient underwent left thoracotomy, decortication, and pericardial window placement.
• He completed 3 weeks of intravenous vancomycin therapy.
• The patient experienced an excellent outcome.

Implications:

• Bacterial pericarditis, though rare, can occur in individuals without traditional risk factors, including those with social habits like smoking and alcohol use.
• Timely recognition and aggressive management, involving pericardial drainage and antibiotics, are vital to prevent severe outcomes.
• A multidisciplinary approach combining surgical drainage and effective antibiotic therapy generally leads to positive outcomes and good long-term prognoses.