Acute pericarditis caused by Kocuria kristinae with successful withdrawal from hemodialysis: a case report

Kocuria kristinae is a commensal skin bacterium that occasionally acts as an opportunistic pathogen. However, it is rarely associated with pericardial infection. This report describes the case of a 47-year-old male patient with dialysis-dependent acute kidney injury (AKI) complicated by massive inflammatory pericardial effusion, in whom K. kristinae was isolated. The patient developed a severe heatstroke, which was followed by AKI, subsequently requiring hemodialysis. Approximately 1 month later, the cardiothoracic ratio increased markedly, and echocardiography revealed substantial pericardial effusion. Anti-inflammatory therapy, comprising non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, elicited a poor response, given no improvement in the effusion. Ultrasound guidance was used for pericardiocentesis, resulting in drainage of 1050 mL of pale-yellow, exudative fluid with neutrophil predominance. K. kristinae was subsequently identified using the VITEK 2 system. The vancomycin dosage was determined based on the susceptibility results. Following the implementation of drainage and antimicrobial therapy, pericardial effusion decreased, venous congestion was alleviated, and urine output increased. These interventions may have contributed to renal recovery and the discontinuation of hemodialysis on day 102. Clinicians should regard K. kristinae isolated from pericardial fluid as a possible contaminant notwithstanding a clinically compatible setting. This case suggests that a massive pericardial effusion with venous congestion can delay renal recovery in severe AKI, whereas successful pericardial drainage facilitates recovery of urine output and withdrawal from hemodialysis.