Abstract 13628: Methicillin-Resistant Staphylococcus Aureus Associated Pericardial Empyema: A Lethal Threat to the Heart

Abstract

Introduction: A highly uncommon but potentially life-threatening condition called Pericardial empyema is a rare but rapidly fatal condition, and in more than half the cases, the diagnosis is postmortem. The most common causal microorganism is Staphylococcus aureus. Case Presentation: A 73-year-old male with a past medical history of type 2 diabetes mellitus and hypothyroidism presented with chills, fever, and a non-healing skin infection on his arm for the last two weeks. Wound and blood cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA). He was started on intravenous Vancomycin. On day 3 of admission, he suddenly developed chest pain. On examination, he had muffled heart sounds with jugular venous distension. Electrocardiogram showed sinus tachycardia with diffuse ST elevation. Laboratory investigations were significant for marked leukocytosis of 28,000/ul, Troponin was 0.056 ng/ml. Bedside transthoracic echocardiography (TTE) showed a large pericardial effusion (Figure 1A). An emergent pericardiocentesis was performed, yielding 250 ml of cloudy serosanguinous fluid. A pericardial window with 28 F drain placement was carried out. A right radial arterial line was placed for further hemodynamic monitoring. The next day, there was a clot in the drain, which after removal, yielded 1000 ml of bloody fluid. Immediate bedside TTE showed no significant effusion or rupture of the myocardium (Figure 1B). The patient suddenly became dyspneic and developed pulseless electrical activity. Code blue was initiated. The patient passed away from cardiopulmonary collapse. Later, the pericardial fluid was positive for MRSA. Conclusions: This case illustrates the importance of timely diagnosis and management of pericardial empyema. Due to its high mortality rate, we encourage professionals to be more aware of this phenomenon's presence as well as its ambiguous clinical outcome.