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Case Reports
. 2021 Jul 14;3(12):1505-1508.
doi: 10.1016/j.cjco.2021.06.020. eCollection 2021 Dec.

Rapid Development of Methicillin-Resistant Staphylococcus aureus (MRSA) Purulent Pericarditis in the Setting of Endocarditis

Samiullah Arshad  1 , Naoki Misumida  2
Affiliations
Case Reports

Rapid Development of Methicillin-Resistant Staphylococcus aureus (MRSA) Purulent Pericarditis in the Setting of Endocarditis

Samiullah Arshad et al. CJC Open. .

Abstract
in English, French

Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis is a rare but potentially fatal complication of MRSA bacteremia. We describe a case of a 27-year-old patient with active intravenous drug use, who presented with fever, chills, and dyspnea and was found to have tricuspid valve endocarditis. Echocardiogram on admission showed no pericardial effusion. The patient became hypotensive, with worsening dyspnea, in the following 3 days. A computed tomography scan of the chest was repeated and showed a large pericardial effusion. The patient underwent pericardiocentesis and pericardial drain placement. Antibiotics were continued, with resolution of effusion. Early pericardiocentesis of a large purulent pericardial effusion may prevent catastrophic outcomes.

La péricardite purulente à Staphylococcus aureus résistant à la méthicilline (SARM) est une complication rare, mais potentiellement mortelle de la bactériémie à SARM. Nous décrivons le cas d’une patiente de 27 ans, consommatrice active de drogues par voie intraveineuse, qui présentait de la fièvre, des frissons et une dyspnée, et chez qui on a découvert une endocardite de la valve tricuspide. L’échocardiogramme à l’admission n’a montré aucun épanchement péricardique. La patiente est devenue hypotendue, et la dyspnée s’est aggravée, dans les trois jours suivants. Un tomodensitogramme de la poitrine a été répété, montrant un important épanchement péricardique. La patiente a subi une ponction péricardique et la pose d’un drain péricardique. Les antibiotiques ont été poursuivis, avec résolution de l’épanchement. La ponction péricardique précoce d’un important épanchement péricardique purulent peut prévenir des résultats catastrophiques.

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Figures

Figure 1
Figure 1
Echocardiogram upon admission. (A) Parasternal long-axis view revealed no pericardial effusion. (B) Right ventricular (RV) inflow view revealed a vegetation (white arrow) attached to tricuspid leaflet. (C) Apical 4-chamber view. RA, right atrium.
Figure 2
Figure 2
Echocardiogram on day 3. (A) Parasternal long-axis view revealed moderate-size circumferential pericardial effusion. (B) Apical 4-chamber view revealed moderate-size circumferential pericardial effusion. (C) Pulse-wave Doppler across the tricuspid valve revealed significant respiratory inflow variation. Every third cardiac cycle is associated with absent tricuspid inflow, presumably during expiration, with the patient breathing at a rate of 30/min, consistent with tamponade.
See this image and copyright information in PMC

References

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