Acute purulent pericarditis secondary to community-acquired streptococcus pneumonia: A case report.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Kevan English, Noelle Pick, Allyson Schmitz
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引用次数: 0

Abstract

Background: Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response. This condition accounts for up to 5% of emergency department visits for nonischemic chest pain in Western Europe and North America. The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes. Acute pericarditis is generally self-limited. However, some cases may be complicated by either tamponade or a large pericardial effusion, which carries a significant risk of recurrence. Risk factors for acute pericarditis include viral infections, cardiac surgery, and autoimmune disorders. A rarer cause of pericardial inflammation includes pneumonia, which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics. Purulent pericarditis carries a high fatality rate, especially in the setting of tamponade, and is invariably deadly without the administration of antibiotics. Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.

Case summary: We present the case of a 62-year-old woman who sought medical attention at the emergency department (ED) due to a 5-day history of chest pain, shortness of breath, and subjective fevers. Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein. A chest X-ray revealed a new focal density within the left lower lung base, and a bedside point-of-care ultrasound showed a pericardial fluid collection. The patient was subsequently admitted, where she underwent pericardiocentesis. Fluid cultures from drainage grew streptococcus pneumoniae. She was started on broad-spectrum antibiotics immediately after the procedure. The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.

Conclusion: This case report emphasizes a unique complication of community-acquired pneumonia. Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium. This condition is virtually fatal without the administration of antibiotics. Therefore, in the context of suspected pneumonia and a new pericardial fluid collection on imaging, clinicians should suspect purulent pericarditis until proven otherwise, which requires emergent intervention.

社区获得性肺炎链球菌继发急性化脓性心包炎1例。
背景:心包炎是由多种刺激引起的心包囊炎症,最终引发刻板免疫反应。在西欧和北美,这种情况占非缺血性胸痛急诊室就诊人数的5%。临床表现最常见的症状是胸痛和呼吸短促,并伴有独特的心电图改变。急性心包炎通常是自限性的。然而,有些病例可能并发心包填塞或大量心包积液,这有很大的复发风险。急性心包炎的危险因素包括病毒感染、心脏手术和自身免疫性疾病。一种罕见的心包炎症的原因包括肺炎,它可以引起化脓性心包炎,自从抗生素出现以来,这种情况越来越罕见。化脓性心包炎具有很高的致死率,特别是在填塞的情况下,并且在不使用抗生素的情况下总是致命的。床边经胸超声心动图是一种快速有效的诊断和治疗方法。病例总结:我们报告一名62岁的女性,因胸痛、呼吸急促和主观发热5天的病史而在急诊科(ED)就诊。ED的实验室检查结果显示白细胞增多,红细胞沉降率和c反应蛋白升高。胸部x光片显示左下肺底有新的病灶密度,床边超声显示心包积液。患者随后入院,在那里她接受了心包穿刺。引流液培养出肺炎链球菌。手术后,她立即开始使用广谱抗生素。患者出院时病情稳定,随访心脏科及感染性疾病。结论:本病例报告强调了一种独特的社区获得性肺炎并发症。由肺炎链球菌引起的化脓性心包炎可通过胸腔内扩散到心包发生。如果不使用抗生素,这种情况几乎是致命的。因此,在疑似肺炎和影像学上新的心包积液的情况下,临床医生应该怀疑化脓性心包炎,直到证实不是这样,这需要紧急干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Clinical Cases
World Journal of Clinical Cases Medicine-General Medicine
自引率
0.00%
发文量
3384
期刊介绍: The World Journal of Clinical Cases (WJCC) is a high-quality, peer reviewed, open-access journal. The primary task of WJCC is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of clinical cases. In order to promote productive academic communication, the peer review process for the WJCC is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCC are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in clinical cases.
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