Rapidly Progressive Constrictive Pericarditis Occurring 10 Days After Purulent Pericarditis

Constrictive pericarditis (CP) typically develops after a chronic course of infection or other etiologies. We report a rare case of acute CP that manifested rapidly following purulent pericarditis (PP). A 63-year-old woman with a history of hematologic disease presented with dyspnea and fever. Pericardial effusion with signs of infection was noted, and emergency pericardial drainage was performed because of hemodynamic instability. Haemophilus influenzae was detected in the pericardial fluid; consequently, antibiotic therapy was initiated. However, the patient's condition deteriorated. Transthoracic echocardiography revealed diastolic dysfunction, leading to the diagnosis of acute CP on hospital day 10 after pericardiocentesis. Given the progressive hemodynamic compromise and treatment failure, open pericardiectomy with pericardial lavage was performed, resulting in rapid improvement in hemodynamics. The patient was discharged ambulatory on postoperative day 28. Although rare, PP can rapidly progress to CP; therefore, early surgical intervention should be considered in cases that do not respond to antibiotic therapy or pericardial drainage.