Purulent pericarditis caused by Streptococcus pyogenes: a case report and review

Area of Science:

• Infectious Diseases
• Cardiology
• Critical Care Medicine

Background:

• Purulent pericarditis is a rare but life-threatening condition.
• Group A Streptococcus (GAS), or *Streptococcus pyogenes*, is an uncommon cause of purulent pericarditis.
• GAS purulent pericarditis is rarely associated with infective endocarditis.

Observation:

• A 43-year-old female presented with altered consciousness and hypotension due to GAS infective endocarditis of the aortic valve.
• Echocardiography revealed a vegetation, aortic regurgitation, and a large pericardial effusion with signs of cardiac tamponade.
• Purulent pericardial fluid was drained, and GAS was identified in cultures, but the patient could not be resuscitated.

Findings:

• This is the first reported case of GAS purulent pericarditis secondary to infective endocarditis.
• Literature review identified 20 cases of GAS purulent pericarditis, mostly in children, with a 40-85% mortality rate.
• Over half of GAS purulent pericarditis cases are diagnosed post-mortem, indicating a need for higher clinical suspicion.

Implications:

• Management requires a multidisciplinary approach, including antibiotics, drainage, and potential surgery.
• Early recognition and intervention are crucial for improving outcomes in GAS purulent pericarditis.
• This case underscores the importance of considering infective endocarditis as a source for purulent pericarditis.