Idiopathic Purulent Pericarditis Caused by Methicillin-Sensitive Staphylococcus Aureus in an Immunocompetent Adult

Abstract

Introduction: Acute purulent pericarditis is an exceedingly rare entity most often caused by direct intrathoracic contamination or hematogenous spread of a bacterial infection. Mortality nears 100% when left untreated. We present here a rare case of idiopathic bacterial pericarditis caused by methicillin-sensitive Staphylococcus aureus (MSSA).

Case: A 69-year-old male presented with chest pain and abdominal pain. He was found to have a pericardial effusion and tamponade and underwent emergent pericardiocentesis. Pericardial fluid culture grew methicillin-sensitive Staphylococcus aureus. The patient required multiple pericardial washouts and was then treated with four weeks of intravenous antibiotics.

Conclusion: While uncommon, clinical suspicion for purulent pericarditis should remain high due to the associated high mortality.

Keywords: bacterial pericarditis; purulent pericarditis.

Figure 1. Initial ECG showing sinus rhythm, premature ventricular complexes, and a left bundle branch block.

ECG = Electrocardiogram

Figure 2. Chest radiograph showing enlarged cardiac silhouette and bibasilar atelectasis.

Figure 3. CT scan of the chest with arrows indicating a large, circumferential pericardial effusion.

CT = Computed tomography

Figure 4. Echocardiogram image performed after pericardial fluid drainage showing small residual effusion (arrows).

Figure 5. Image of the patient's heart inside the mediastinal cavity, one day after initial pericardial washout was performed. The heart appears edematous but no purulent material has re-accumulated.