Chand Gaurav, Jhaj Ruby, Sanam Kumar, Sinha Prabhat, Alexander Patrick
Department of Internal Medicine, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
Department of Cardiology, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
Ann Med Surg (Lond). 2016 Mar 29;7:83-6. doi: 10.1016/j.amsu.2016.03.024. eCollection 2016 May.
Non-typhoidal Salmonella (NTS) is mostly restricted to gastroenteritis; however, we report a case of Salmonella pericarditis complicated by tamponade and spontaneous ventricular wall rupture.
A 67-year-old male presents to the Emergency Department with complaints of fevers, chills and body aches. A chest radiograph displayed an infiltrate and an electrocardiogram suggested acute pericarditis. An echocardiogram revealed a small pericardial effusion without tamponade. Broad-spectrum antibiotics were initiated until Salmonella was discovered in blood cultures. The hospital course was complicated by sudden decompensation, and a repeat echocardiogram displayed a large effusion with constrictive physiology. During a pericardial window, the tissue was noted to have a thickened appearance with a complex effusion. The following day, the patient developed increased chest tube drainage, hypotension and acidosis, requiring an emergent sternotomy. The right ventricle was friable and had spontaneously ruptured. After ventricular repair and pericardiectomy, the tissue was sent for cultures and pathology. The specimen revealed Salmonella enteriditis. Treatment with ceftriaxone and ciprofloxacin was initiated. On postoperative day four, the patient was successfully extubated. Repeat blood cultures were negative.
In our review of literature, only 19 cases of NTS pericarditis have been reported. Prior to our case, salmonellosis resulting in ventricular rupture has been reported once. Early diagnosis and treatment is crucial in minimizing morbidity and mortality. Clinical suspicion based on electrocardiogram and hemodynamic assessment is critical in suspecting pericardial effusion in a patient with nonspecific symptoms and Salmonella bacteremia. The key to recovery involves aggressive treatment, including pericardiectomy and antibiotic treatment.
非伤寒沙门氏菌（NTS）大多局限于引起肠胃炎；然而，我们报告一例沙门氏菌心包炎并发心包填塞和自发性心室壁破裂的病例。
一名67岁男性因发热、寒战和身体疼痛就诊于急诊科。胸部X光片显示有浸润影，心电图提示急性心包炎。超声心动图显示有少量心包积液，无心包填塞。开始使用广谱抗生素，直到血培养发现沙门氏菌。住院过程中病情突然恶化，复查超声心动图显示有大量积液并有缩窄性生理改变。在进行心包开窗术时，发现组织外观增厚并有复杂性积液。第二天，患者胸腔引流增加、出现低血压和酸中毒，需要紧急行胸骨切开术。右心室脆弱且已自发破裂。在进行心室修复和心包切除术后，将组织送去做培养和病理检查。标本显示为肠炎沙门氏菌。开始使用头孢曲松和环丙沙星治疗。术后第四天，患者成功脱机。复查血培养结果为阴性。
在我们查阅的文献中，仅报告了19例NTS心包炎病例。在我们的病例之前，曾有一次报道沙门氏菌病导致心室破裂。早期诊断和治疗对于将发病率和死亡率降至最低至关重要。对于有非特异性症状和沙门氏菌血症的患者，基于心电图和血流动力学评估的临床怀疑对于怀疑心包积液至关重要。恢复的关键在于积极治疗，包括心包切除术和抗生素治疗。
