Cmor Nino, Dora Eva, Lainscak Mitja, Tibaut Miha
Division of Cardiology, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Eur Heart J Case Rep. 2024 Aug 13;8(9):ytae427. doi: 10.1093/ehjcr/ytae427. eCollection 2024 Sep.
Polymicrobial pericarditis is an extremely rare and lethal form of pericarditis. Prompt initiation of appropriate antimicrobial treatment and pericardial drainage are crucial.
A 57-year-old immunocompromised male patient presented to the emergency department due to dyspnoea, chest pain, and fever lasting for 7 days. Following clinical, laboratory, and imaging work-up, he was found to have pericardial effusion with signs of tamponade. After pericardiocentesis through subxiphoid and apical approaches, 800 mL of gross purulent fluid was obtained. Blood and pericardial fluid cultures confirmed the diagnosis of polymicrobial purulent pericarditis ( and ). Further work-up revealed minor peritoneal effusion, and paracentesis fluid culture revealed the presence of and, additionally, . After treatment initiation with intravenous antibiotics, pericardial, drainage and supportive measures, the patient's condition initially improved despite the development of constrictive pericarditis. However, he suddenly deteriorated after 37 days of hospitalization and passed away after 51 days of hospitalization.
To the best of our knowledge, this is the first report of purulent pericarditis and purulent peritoneal effusion in the settings of bacteraemia with an absent primary infection focus. Clinicians should be aware of treatment options for purulent pericarditis and consider intrapericardial fibrinolysis, especially in patients not suited for more invasive pericarditis treatment.
多微生物性心包炎是一种极其罕见且致命的心包炎形式。及时开始适当的抗菌治疗和心包引流至关重要。
一名57岁免疫功能低下的男性患者因呼吸困难、胸痛和发热持续7天就诊于急诊科。经过临床、实验室和影像学检查，发现他有心包积液并有心脏压塞的迹象。经剑突下和心尖途径进行心包穿刺后，获得了800毫升脓性液体。血液和心包液培养确诊为多微生物性脓性心包炎（ 和 ）。进一步检查发现有少量腹腔积液，腹腔穿刺液培养显示存在 ，此外还有 。在开始静脉使用抗生素、心包引流和支持治疗后，尽管出现了缩窄性心包炎，但患者的病情最初有所改善。然而，他在住院37天后突然病情恶化，住院51天后去世。
据我们所知，这是首例在无原发性感染灶的 菌血症情况下发生脓性心包炎和脓性腹腔积液的报告。临床医生应了解脓性心包炎的治疗选择，并考虑心包内纤维蛋白溶解，特别是对于不适合更具侵入性心包炎治疗的患者。
