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Published on: April 7, 2015
Polymicrobial pericarditis caused by bacterial and fungal translocation from an oesophageal ulcer
Michael Holman1, Greeshma Kambam2, Coen Lap3
1Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA michaelholman30@gmail.com.
Abstract:
This case report discusses a rare instance of polymicrobial pericarditis in a man in his early 60s with a history of substance abuse. The patient presented with chest pain and shortness of breath, later diagnosed as pericarditis caused by Streptococcus anginosus, S. intermedius and Candida glabrata, likely originating from a large adjacent oesophageal ulcer. The condition led to critical illness, requiring pericardiocentesis, antibiotic and antifungal therapy. Despite initial improvement, the patient experienced recurrence and ultimately underwent pericardectomy. The article emphasises the rarity and severity of polymicrobial pericarditis, often associated with high mortality. It underscores the importance of prompt recognition, broad-spectrum antibiotics and source control, particularly when the gastrointestinal tract is implicated. The case highlights the challenges in managing such cases and the potential need for surgical intervention for optimal outcomes.
Insights
This case report details a rare polymicrobial pericarditis caused by Streptococcus and Candida species, originating from an esophageal ulcer. Prompt diagnosis and broad-spectrum treatment are crucial for managing this severe condition.
Area of Science:
- Infectious Diseases
- Cardiology
Background:
- Polymicrobial pericarditis is a rare and severe infection.
- Substance abuse can be a risk factor for serious infections.
Observation:
- A patient presented with chest pain and shortness of breath.
- Diagnosis revealed pericarditis caused by Streptococcus anginosus, Streptococcus intermedius, and Candida glabrata.
- The infection likely originated from an adjacent esophageal ulcer.
Findings:
- The patient experienced critical illness requiring pericardiocentesis and antimicrobial therapy.
- Recurrence of the infection necessitated a pericardectomy.
- Polymicrobial pericarditis, especially with gastrointestinal origin, carries a high mortality risk.
Implications:
- Early recognition and broad-spectrum antibiotic/antifungal treatment are vital.
- Source control, particularly for gastrointestinal-related infections, is critical.
- Surgical intervention may be necessary for optimal management of refractory cases.
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