Primary pericardial abscess caused by Staphylococcus aureus infection without a predisposing condition.

Abstract

A 75-year-old man presented to the hospital with a low-grade fever and worsening dyspnea. Transthoracic echocardiogram and contrast-enhanced computed tomography revealed a 20 × 20 mm lesion adjacent to the left ventricle with pericardial effusion. We suspected pericardial abscess, but no bacteria were detected even after 6 consecutive blood cultures. Ultimately, we drained 500 mL serosanguinous fluid from the pericardial effusion on the 4th hospital day; a subsequent culture grew methicillin-sensitive Staphylococcus aureus. Although we performed percutaneous and surgical drainage and intravenous administration of antibiotics, he developed constrictive pericarditis, and died due to multi-organ failure on the 21st hospital day. On histological examination, neutrophil infiltration was noted in the thickened pericardium and the myocardium. To our knowledge, a purulent pericarditis complicated pericardial abscess can occur without bacteremia, and early diagnosis and aggressive management are necessary for a good prognosis. <Learning objective: Pericardial abscess (PA) is a rare but serious life-threatening illness. We report the case of a patient with primary PA induced by S. aureus infection without a predisposing condition. A purulent pericarditis complicated PA can occur without bacteremia being detected from sequential blood cultures. Early diagnosis and aggressive management are vital to ensure a good prognosis.>.

• Authors: Yasuhisa Nakao, Tadanao Higaki, Yasuharu Nakama, Toshiaki Morito, Kazuyoshi Suenari, Kenji Nishioka, Yoshiko Masaoka, Hideo Yoshida, Nobuo Shiode
• Journal: Journal of cardiology cases (J Cardiol Cases) Vol. 20 Issue 3 Pg. 73-76 (Sep 2019) ISSN: 1878-5409 [Electronic] Japan
• PMID: 31497168 (Publication Type: Case Reports)