Fulminant Staphylococcus aureus Pancarditis in an Immunocompetent Adult

Infective endocarditis (IE) is rare and deadly. We report the case of IE rapidly progressing to pancarditis.

A man in his 60s with no medical history presented with fever, chest pain, and embolic phenomena. Initial evaluation suggested myocardial infarction, but angiography was normal. Echocardiography revealed an aortic valve vegetation. Blood cultures grew methicillin-sensitive Staphylococcus aureus. Despite appropriate antibiotics, he developed rapidly progressive purulent pericardial effusion and died. Pericardial fluid cultures confirmed S aureus purulent pericarditis, establishing the diagnosis of pancarditis involving endocardium, myocardium, and pericardium.

Bacterial pancarditis is an exceedingly rare and severe complication of IE. Pericardial effusion associated with IE should raise suspicion for purulent pericarditis and prompt rapid referral for surgical drainage or diagnostic puncture.

Consider bacterial pancarditis when IE is complicated by myocardial and pericardial involvement. Pericardial effusion in IE requires prompt investigation and drainage or at least a diagnostic puncture.