Primary pericardial abscess caused by Staphylococcus aureus infection without a predisposing condition

• Published in: Journal of cardiology cases Vol. 20; no. 3; pp. 73 - 76
• Main Authors: Nakao, Yasuhisa, Higaki, Tadanao, Nakama, Yasuharu, Morito, Toshiaki, Suenari, Kazuyoshi, Nishioka, Kenji, Masaoka, Yoshiko, Yoshida, Hideo, Shiode, Nobuo
• Format: Journal Article
• Language: English
• Published: Japan Elsevier Ltd 01.09.2019; Japanese College of Cardiology
• Subjects: Constrictive pericarditis; Pericardial abscess; Purulent pericarditis; Staphylococcus aureus; Purulent pericarditis; Constrictive pericarditis; Pericardial abscess; Staphylococcus aureus
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2019.04.004

A 75-year-old man presented to the hospital with a low-grade fever and worsening dyspnea. Transthoracic echocardiogram and contrast-enhanced computed tomography revealed a 20 × 20 mm lesion adjacent to the left ventricle with pericardial effusion. We suspected pericardial abscess, but no bacteria were detected even after 6 consecutive blood cultures. Ultimately, we drained 500 mL serosanguinous fluid from the pericardial effusion on the 4th hospital day; a subsequent culture grew methicillin-sensitive Staphylococcus aureus. Although we performed percutaneous and surgical drainage and intravenous administration of antibiotics, he developed constrictive pericarditis, and died due to multi-organ failure on the 21st hospital day. On histological examination, neutrophil infiltration was noted in the thickened pericardium and the myocardium. To our knowledge, a purulent pericarditis complicated pericardial abscess can occur without bacteremia, and early diagnosis and aggressive management are necessary for a good prognosis. <Learning objective: Pericardial abscess (PA) is a rare but serious life-threatening illness. We report the case of a patient with primary PA induced by S. aureus infection without a predisposing condition. A purulent pericarditis complicated PA can occur without bacteremia being detected from sequential blood cultures. Early diagnosis and aggressive management are vital to ensure a good prognosis.>