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Community-associated Methicillin-resistant Staphylococcus aureus pericarditis in an immunocompetent patient
Dorde Jevtic1,2, Igor Dumic3,4, Adam Adam1
1Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Background:
Pericarditis caused by Methicillin-resistant Staphylococcus aureus (MRSA) is a rare infection, often seen in patients with chronic kidney disease, immunosuppression, or previous pericardial disease. The presentation can be dramatic with acute illness leading to septic and/or obstructive shock due to pericardial tamponade. Occasionally disease can have a more protracted, indolent, subacute clinical course.
Case Report:
We report a case of a 57-year-old male patient with a previous history of smoking and moderate alcohol use who presented with progressive dyspnea and cough. He was found to have a disseminated MRSA infection with pericarditis complicated by pericardial tamponade. Urgent pericardiocentesis yielded 1.1 liters of purulent fluid that grew MRSA. MRSA was also isolated from the blood and pleural fluid. The patient underwent left thoracotomy, decortication, and pericardial window and completed 3 weeks of intravenous vancomycin therapy, concluding in an excellent outcome.
Conclusion:
Bacterial pericarditis is an exceptionally rare form of pericarditis which been traditionally associated with chronic medical conditions requiring a prolonged healthcare stay. However, it has lately been observed in healthy individuals with social habits such as smoking and alcohol consumption. Bacterial pericarditis must be recognized in a timely fashion and managed aggressively to prevent a devastating outcome. A multidisciplinary approach is advised, which includes a combination of pericardial drainage and aggressive antibiotic therapy. Such treatment often yields a positive outcome and good long-term prognosis.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) pericarditis is a rare but serious infection. Prompt diagnosis and aggressive treatment, including drainage and antibiotics, are crucial for a positive outcome, even in seemingly healthy individuals.
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.
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