Chronic purulent pericarditis: case report

Abstract

Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.

Keywords: Chronic pericarditis; TB pericarditis; case report; purulent pericarditis.

Figure 1

timeline of the patient's illness

Figure 2

chest X-ray on admission showing massive bilateral pleural effusion

Figure 3

a bottle filled with pus collected after pericardiocentesis

Figure 4

(A, B) CT scan of the chest showing bilateral partial atelectasis, more on the right lung and pericardial thickening of about 6.9 mm

Figure 5

H & E stain slide of the pericardium

Figure 6

ZN stain histopathology slide of the pericardium