Purulent pericarditis in a patient with community-acquired methicillin-resistant Staphylococcus aureus: a case report with mini-review

Abstract

Introduction: The etiopathogenesis of purulent pericarditis has changed significantly in modern antibiotic era with the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the last few decades. Pericarditis due to MRSA is rarely reported in the literature without risk factors like immunosuppression, thoracic surgery, chest trauma or pre-existing pericardial diseases.

Case report: We describe an 18-year-old male who presented with 5 days history of fever, chest pain and shortness of breath. Echocardiogram and thorax CT showed significant pericardial effusion. The patient underwent pericardiocentesis, MRSA was isolated from blood and pericardial fluid. The patient improved with intravenous antibiotics (linezolid). Follow-up echocardiography at 3 months was unremarkable, without any residual fluid or features of constrictive pericarditis.

Discussion: In the absence of known risk factors, MRSA is an extremely rare cause of pericarditis in modern antibiotics era. The possibility of MRSA pericarditis should be sought in every case of pericarditis to achieve prompt diagnosis and treatment.

Conclusions: Our case highlights the role of aggressive pericardiocentesis and appropriate antibiotic therapy in purulent pericarditis.

Keywords: Pericardial effusion; community acquired infection; methicillin-resistant Staphylococcus aureus; purulent pericarditis.

Figure 1. 1a Axial post contrast CT thorax shows moderate pericardial effusion without significant enhancement of the pericardium. Note the associated moderate right sided pleural effusion (white arrow) and minimal left sided pleural effusion, 1b Coronal post-contrast images show the pericardial effusion with pericardial drain in situ (white arrow).