Purulent Pericarditis as an Initial Manifestation of Infective Endocarditis in a Hemodialysis Patient: A Case Report.

Abstract

Introduction: Infective endocarditis can present with a wide range of cardiac and extra-cardiac symptoms. However, purulent pericarditis as a presenting sign has rarely been documented in the literature.

Case description: We present a case of a 47-year-old woman on hemodialysis who presented to the emergency department due to dyspnea and edema in her lower extremities. A chest X-ray revealed an enlarged cardiac silhouette, while a computed tomography (CT) scan showed a large pericardial effusion. A transthoracic echocardiogram indicated vegetation on the tricuspid valve and pericardial effusion, with echocardiographic signs of cardiac tamponade. Emergent drainage of the pericardial space was performed, during which purulent material was obtained. Methicillin-resistant Staphylococcus aureus was identified in blood cultures collected upon admission and in the cultures from the pericardial effusion. The patient received intensive antibiotic therapy; however, despite the treatment and after a complicated hospital course, she succumbed to the illness.

Conclusion: Diagnosing purulent pericarditis in hemodialysis patients with infective endocarditis requires a high level of suspicion because typical symptoms of pericarditis are uncommon, and there is a tendency to initially attribute nonspecific constitutional symptoms to the underlying infection itself. Aggressive treatment with pericardial drainage and appropriate antibiotic therapy may prevent catastrophic outcomes.