Abstract 11918: Simultaneous Presentation of Pyogenic Pericarditis, Coronavirus Infection, and Endocarditis: A Challenging Triad in a Single Patient

Abstract

Background: Pyogenic pericarditis is a rapidly progressive infection with high mortality near 100%. In the present antibiotic age, bacterial pericarditis is an uncommon cause of acute pericarditis. The reported incidence of pyogenic pericarditis is less than 1% of all pericarditis cases. Case: 54 year-old male patient that presented with complaints of generalized weakness, fatigue, and fever. He was diagnosed with Coronavirus 229E by PCR. He was in respiratory distress, and CT chest showed concern for large pericardial effusion. Transthoracic echocardiogram showed large pericardial effusion (Image) without tamponade effect. Patient decompensated overnight and bedside point of care ultrasound overnight showed concern for tamponade effect. Pericardial window was performed and 800 ml thick purulent drainage evacuated. While in the ICU patient underwent transesophageal echocardiogram that showed Small hyper-mobile echo-density on the aortic valve concerning for endocarditis (image). Patient also had Type 1 Bicuspid aortic valve with heavily calcified raphe. Cultures on the pericardial effusion grew methicillin sensitive Staphylococcus Aureus. Patient will need 6 weeks of IV antibiotics and aortic valve replacement. Infectious disease recommended lifelong suppression therapy for MSSA. Decision-making: It is not uncommon for bacterial endocarditis and viruses to cause pericardial effusions. It is uncommon for a patient to have bacterial endocarditis, Coronavirus, and be diagnosed with pyogenic pericardial effusion. Cardiac tamponade is a clinical emergency, and evacuation of pericardial fluid to assist reduce the pressure surrounding the heart is used to treat cardiac tamponade. Conclusion: Here we present a case to our knowledge that has never been described before. This is a case of a patient that had infective endocarditis with confirmed Coronavirus that resulted in a pyogenic pericardial effusion.