Purulent Pericarditis: Is It Really a Disease of the Past?

Abstract

The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key.

Learning points: Purulent pericarditis is a rare infection, mostly resulting from contiguous or haematogenous spread, with diagnosis often delayed because signs and symptoms are unspecific.Treatment must include drainage of the pericardial space, combined with systemic antibiotics.Prognosis is variable, depending largely on the speed of diagnosis and treatment, as death is almost certain without adequate source control.

Keywords: Bacterial pericarditis; acute mediastinitis; pericardiocentesis; secondary pericarditis.