Pyopneumopericarditis from a gastropericardial fistula: a case report

Background Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with associated inflammation of the fibrous pericardial sac. Case summary A 49-year-old gentleman was admitted with pyopneumoperciarditis on a background of a previous uncomplicated Roux-en-Y gastric bypass surgery performed 7 years prior. He underwent emergency surgery for an omental patch repair of an ulcer perforation involving the diaphragm and pericardium. His inpatient stay was complicated by persistent seropurulent output from the pericardial drain, loculated pleural effusion, and deconditioning. Discussion Management is extrapolated from the literature regarding purulent pericarditis. This condition albeit rare, requires swift recognition as without treatment mortality approaches 100%. Colchicine is an important adjunctive therapy postoperatively to prevent constrictive physiology.

Two-Dimensional Transthoracic Echocardiographic Demonstration of Reduction in Fibrin Content in Purulent Pericarditis Following Intrapericardial Fibrinolytic Agent Administration

We describe an adult patient who presented with purulent pericarditis in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images have not been reported previously in an adult patient with purulent pericarditis, to the best of our knowledge.

Purulent pericarditis, an unusual cause of cardiac arrest

Purulent pericarditis is a rare infection of the pericardial space defined by the presence of gross pus or microscopic purulence. Here, we present a case of Streptococcus anginosus purulent pericarditis, leading to obstructive and septic shock. After prompt pericardial drainage, the patient experienced rapid improvement in symptoms. However, due to the presence of a loculated effusion and concern for development of constrictive pericarditis, a pericardial window was performed. Although purulent pericarditis is often fatal, this case illustrates the reduced morbidity following prompt recognition and drainage.

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

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.

A case report of fulminant primary streptococcal pericarditis

Background Bacterial pericarditis is a rare, rapidly progressive, and highly fatal infection, even with drainage and antibiotics. Gram-positive cocci, specifically Streptococcus pneumoniae, have been the most common cause of bacterial pericarditis from either haematogenous dissemination, or spread from another adjacent site of infection. Following the introduction of antibiotics in the 1940s and more recently the pneumococcal conjugate vaccine, the incidence has drastically decreased. Case summary A previously healthy young male was diagnosed with acute pericarditis with no signs of haemodynamic compromise on initial presentation. Several hours later, he became unstable suffering from cardiac tamponade and septic shock. Despite urgent pericardiocentesis and drainage of purulent fluid, culture positive for streptococcus pneumoniae, multi-organ failure was eventually fatal. Discussion We describe a rare case of primary S. pneumoniae purulent pericarditis leading to tamponade, septic shock, and death. Due to the high mortality rate of purulent pericarditis, a high index of suspicion is needed in order to initiate appropriate therapy with antibiotics and drainage.