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Purulent Pericarditis Following Endobronchial Biopsy of Lymph Node (4R): A Rare Case of Streptococcus mitis

Vijay Gupta1, Marie-Eve Mathieu2, Shaun A Hanycz1

  • 1Department of Medicine, Schulich School of Medicine & Dentistry, London, Ontario, Canada.

JACC. Case Reports
|July 4, 2025
PubMed
Abstract

Insights

Purulent pericarditis, a rare complication of endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA), can lead to cardiac tamponade. This case details successful management of Streptococcus mitis pericarditis post-EBUS-FNA.

Area of Science:

  • Pulmonology
  • Cardiology
  • Infectious Diseases

Background:

  • Purulent pericarditis is a rare but serious complication following endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA).
  • Intrathoracic lymph node sampling via EBUS-FNA carries a risk of iatrogenic infection.

Observation:

  • A 65-year-old male developed purulent pericarditis with cardiac tamponade after EBUS-FNA of a mediastinal lymph node.
  • Transthoracic echocardiography revealed significant pericardial effusion with fibrinous stranding and signs of tamponade.
  • Pericardiocentesis yielded purulent fluid, identified as Streptococcus mitis.

Findings:

  • This is the first reported case of purulent pericarditis caused by Streptococcus mitis following EBUS-FNA.
  • The patient received a prolonged course of intravenous antibiotics guided by microbial cultures.
  • Successful management was achieved with targeted antibiotic therapy.

Implications:

  • EBUS-FNA requires awareness of potential infectious complications like purulent pericarditis.
  • Transthoracic echocardiography is crucial for diagnosing pericardial effusions and tamponade post-procedure.
  • Prompt diagnosis and culture-guided antibiotic treatment are vital for favorable outcomes in purulent pericarditis.
Keywords:
complicationechocardiographyeffusive constrictive pericarditisendobronchial ultrasound-guidedfine-needle aspirationtamponade

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