Pneumococcal Pyopericardium With Xiphoid Osteomyelitis in HIV/AIDS: A Rare but Potentially Fatal Complication

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Purulent pericarditis is a rare but life-threatening infection, increasingly seen in immunocompromised individuals.
• Antibiotic use has reduced its incidence, but opportunistic infections remain a risk.
• It often arises from secondary bacterial spread.

Observation:

• A 55-year-old man with HIV cardiomyopathy presented with chest pain and dyspnea.
• Initial cardiac catheterization showed normal coronary arteries, but echocardiography revealed pericardial effusion with tamponade.
• Pericardial fluid analysis identified Streptococcus pneumoniae.

Findings:

• The patient required pericardiocentesis and later a subxiphoid pericardial wash due to reaccumulating effusion.
• A concurrent diagnosis of acute osteomyelitis of the xiphoid was made.
• Treatment involved antibiotics and drainage procedures.

Implications:

• This case underscores the risk of opportunistic infections like pneumococcal pyopericardium in HIV patients, even with antiretroviral therapy.
• Prompt diagnosis and multidisciplinary management are crucial for improving outcomes in this rare condition.
• It highlights advancements in managing purulent pericarditis with tamponade.