Abstract 11934: A Unique Presentation of Idiopathic Purulent Pericardial Effusion With Tamponade & Atrial Fibrillation

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A11934
• Main Authors: Suri, Sarabjeet S, Kitchloo, Karishma
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.11934

IntroductionPurulent pericardial effusions have high mortality ratestreated cases have a mortality of 40%-untreated, they are fatal. We present a case of purulent pericardial effusion presenting with new onset A fib.CaseAn 81 year old woman with HFrEF presented with exertional intermittent left sided chest pain. She reported no fever or URI symptoms. She was afebrile, BP 104/70 mmHg. Physical exam was significant for irregularly irregular rhythm, no JVD. EKG revealed A fib with RVR at 130 bpm. Labs revealed troponin <0.01, pro-BNP 571 pg/mL, WBC 7.7. Chest xray revealed with cardiomegaly. Infectious and autoimmune work up was unremarkable. TTE revealed large pericardial effusion with diastolic right heart collapse, for which she underwent pericardiocentesis with removal of 550 mL of serosanginuous fluid. Fluid culture grew Staphylococcus caprae in multiple cultures bottles. CT chest and abdomen was negative for malignancy or any infectious source. She was treated with cefazolin. Repeat TTE confirmed resolution of effusion.DiscussionIn the post antibiotic era, purulent pericardial effusions are rarely seen in developed world. Most cases are associated with bloodstream infection, intra-thoracic trauma/surgery or immunocompromised state. Patients usually present with fever, tachycardia and pleuritic chest pain. In the acute setting, patients may present with tamponade. Investigation usually reveals leukocytosis, abnormal XR chest with cardiomegaly or pulmonary infiltrates. EKG can present with electrical alterans (35 % patients have normal EKG). A fib as a presenting symptom is rare. Common organism involved includes S. aureus and S. Pneumonia. No prior case report has been published with S. Caprae as the cause. TB remains the most common cause in endemic areas. Treatment involves pericardiocentesis. Antibiotics should be started as soon as diagnosis of purulent pericarditis is suspected. Therapy should target gram positive and gram negative organisms. Fungal coverage should be included if the patient is immunocompromised. The therapy should be tailored based on culture data. Despite high mortality rate even with treatment, our patient survived.