Primary Streptococcus pneumoniae pericarditis

Abstract

Although commonly fatal, bacterial pericarditis is often not diagnosed antemortem due to its infrequent occurrence and fulminant course. Historically, Streptococcus pneumoniae has been the most common cause of bacterial pericarditis. Over the past 70 years, however, it has become largely eliminated and now occurs almost exclusively in immunocompromised individuals with a preceding primary site of infection. Herein, we present a case of primary S. pneumoniae pericarditis that developed over the course of 3 to 4 weeks in an immunocompetent 45-year-old man. The patient, who developed cardiac tamponade shortly after admission, experienced a rapid resolution of symptoms following pericardial drainage and initiation of antibiotics.

Figure 1

Admission electrocardiogram demonstrating diffuse ST segment elevation, most prominent in the anterior precordial leads with reciprocal ST segment depression in lead AVR.

Figure 2

Parasternal short-axis view of a transthoracic echocardiogram revealing a large echo-free space, suggesting an extensive circumferential pericardial effusion (see arrow and white bar). RV indicates right ventricle; LV, left ventricle.

Figure 3

Right heart catheterization tracing of the right atrium showing blunting of the y descent consistent with cardiac tamponade. The mean right atrial pressure was measured at 18 mm Hg.