Wagle Laxman, Basnyat Parmartha, Timshina Anuj, Regmi Rashmita, Sherpa Lakpa Diku, Poudel Sishir
Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA.
Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu.
Ann Med Surg (Lond). 2024 Sep 10;86(10):6311-6316. doi: 10.1097/MS9.0000000000002552. eCollection 2024 Oct.
Purulent pericarditis is an uncommon complication of , which commonly occurs in an immunocompromised state such as HIV and can lead to life-threatening complications such as cardiac tamponade and potentially death if untreated. Early identification, pericardiocentesis, and general measures such as antibiotics and anti-inflammatory medications can be life-saving.
The authors present a case of a 64-year-old male with HIV who presented with clinical symptoms suggestive of pericarditis. Chest imaging revealed multifocal airspace diseases and moderate pericardial effusion. He had worsening lactic acidosis, and bedside point-of-care ultrasound showed pericardial effusion with features suggestive of cardiac tamponade. His lactic acidosis improved with emergency pericardiocentesis. Blood and pericardial fluid cultures revealed . He was further treated with intravenous antibiotics, colchicine, and ibuprofen.
Although is a common etiology of community-acquired pneumonia (CAP), it has not been cited as the leading cause of pericarditis or pericardial effusion. In immunocompromised patients, it is necessary to consider a broad differential diagnosis as an etiology of acute chest pain, as it may be challenging to differentiate pleuritic and pericarditic chest pain from clinical presentation only. Moreover, infectious etiology of acute pericarditis and pericardial effusion should be considered in this patient population, especially those with HIV. At the same time, it is crucial to promptly identify and treat cardiac tamponade to prevent further deterioration.
This case provides insight into the diagnosis and management of CAP and its potential complication of purulent pericarditis and cardiac tamponade in immunocompromised patients.
脓性心包炎是一种不常见的并发症，常见于免疫功能低下状态，如感染HIV时，若不治疗可导致危及生命的并发症，如心脏压塞甚至死亡。早期识别、心包穿刺术以及使用抗生素和抗炎药物等一般措施可能挽救生命。
作者报告一例64岁感染HIV的男性患者，其出现提示心包炎的临床症状。胸部影像学显示多灶性气腔疾病和中度心包积液。他的乳酸酸中毒病情加重，床旁即时超声显示心包积液并有提示心脏压塞的特征。紧急心包穿刺术后他的乳酸酸中毒有所改善。血液和心包液培养显示…… 他进一步接受了静脉抗生素、秋水仙碱和布洛芬治疗。
虽然……是社区获得性肺炎（CAP）的常见病因，但它未被列为心包炎或心包积液的主要原因。在免疫功能低下的患者中，有必要对急性胸痛的病因进行广泛的鉴别诊断，因为仅从临床表现来区分胸膜炎性胸痛和心包炎性胸痛可能具有挑战性。此外，对于这类患者群体，尤其是感染HIV的患者，应考虑急性心包炎和心包积液的感染性病因。同时，及时识别和治疗心脏压塞以防止病情进一步恶化至关重要。
本病例为免疫功能低下患者中CAP及其潜在并发症脓性心包炎和心脏压塞的诊断和管理提供了见解。
