Eng-Frost Joanne, Murray Lewis, Lorensini Scott, Harjit-Singh Rajinder Singh
Department of Cardiology, Flinders Medical Centre, Level 6, Flinders Drive, Bedford Park, SA 5042, Australia.
Eur Heart J Case Rep. 2022 Jun 28;6(7):ytac260. doi: 10.1093/ehjcr/ytac260. eCollection 2022 Jul.
Purulent bacterial pericarditis (PBP) is a highly lethal infection of the pericardial space that arises as a complication of infective illnesses. Purulent bacterial pericarditis remains a diagnostic challenge given its non-specific clinical and investigative features and carries exceedingly high mortality rates due to fulminant sepsis and morbidity including constrictive pericarditis in survivors. We present our management of cardiac tamponade and subsequent constrictive pericarditis due to PBP.
A 53-year-old Caucasian male presented with acute New York Heart Association Class IV dyspnoea and chest discomfort, in the context of multiple hospital presentations over the preceding 8 weeks due to presumed recurrent viral pericarditis. On this admission, initial transthoracic echocardiography (TTE) demonstrated a large asymmetric pericardial effusion for which he underwent urgent pericardiocentesis. Serial TTE post-pericardiocentesis, however, demonstrated effusion re-accumulation and effusive-constrictive pericarditis, confirmed on cardiac magnetic resonance imaging. Fluid culture was positive for . He was diagnosed with PBP, but his condition deteriorated despite appropriate intravenous antibiotic therapy, necessitating semi-urgent surgical pericardiectomy. He recovered well and was discharged on Day 10 post-operatively.
Unlike uncomplicated acute viral or idiopathic pericarditis, PBP portends a very poor prognosis if unrecognized and untreated. Diagnostic challenges persist given its rarity in modern clinical practice; however, PBP should be considered in cases of seemingly recurrent pericarditis. Multi-modal cardiac imaging and careful analysis of pericardial fluid including cultures and lactate dehydrogenase/serum ratios may assist in earlier recognition. In this case, source control and symptom relief were achieved only with combined intravenous antibiotics, surgical evacuation, and pericardiectomy.
化脓性细菌性心包炎（PBP）是一种心包腔的高致死性感染，是感染性疾病的并发症。由于其非特异性的临床和检查特征，化脓性细菌性心包炎仍然是一个诊断难题，并且由于暴发性脓毒症以及幸存者中包括缩窄性心包炎在内的发病率，其死亡率极高。我们介绍了因PBP导致的心包填塞及随后的缩窄性心包炎的治疗情况。
一名53岁的白种男性因急性纽约心脏病协会IV级呼吸困难和胸部不适前来就诊，在过去8周内曾因疑似复发性病毒性心包炎多次住院。此次入院时，初始经胸超声心动图（TTE）显示大量不对称心包积液，为此他接受了紧急心包穿刺术。然而，心包穿刺术后的系列TTE显示积液再次积聚以及渗出性缩窄性心包炎，心脏磁共振成像证实了这一点。液体培养显示 阳性。他被诊断为PBP，但尽管接受了适当的静脉抗生素治疗，其病情仍恶化，因此需要进行半紧急外科心包切除术。他恢复良好，术后第10天出院。
与无并发症的急性病毒性或特发性心包炎不同，PBP如果未被识别和治疗，预后非常差。鉴于其在现代临床实践中罕见，诊断挑战依然存在；然而，在看似复发性心包炎的病例中应考虑PBP。多模态心脏成像以及对心包液进行仔细分析，包括培养和乳酸脱氢酶/血清比值，可能有助于早期识别。在本病例中，仅通过联合静脉抗生素、手术引流和心包切除术才实现了源头控制和症状缓解。
