Abstract
Bacterial pericarditis is a critical diagnosis caused by a wide range of organisms including Streptococcus pneumoniae and other anaerobic organisms like Cutibacterium acnes which has been gaining more importance as a causative organism. Cutibacterium species are Gram-positive microaerophilic rods that constitute part of the normal flora of skin and mucosal membranes. The incidence of pericarditis caused by this organism is underreported as it is often dismissed as a skin flora contaminant. However, if left untreated, Cutibacterium acnes can cause pericarditis with serious complications. In this paper, we present a comprehensive review of the literature regarding pericarditis caused by Cutibacterium acnes along with a case presentation from our institution. In our institution, a 20-year-old man with history of atrial septal defect presented with chest pain radiating to the back along with symptoms of upper respiratory tract infection including headaches and myalgia. Electrocardiogram was remarkable for diffuse low-voltage waves. Echocardiography revealed a large pericardial effusion with tamponade features. Pericardiocentesis drained 1.2 L of milky fluid. Pericardial fluid analysis grew Cutibacterium acnes after being cultured for 8 days. The patient received 3 weeks of IV penicillin followed by 3 weeks of oral amoxicillin along with nonsteroidal anti-inflammatory agents and colchicine with no recurrence. Pericarditis caused by Cutibacterium acnes requires a high clinical suspicion since isolation of this organism can be dismissed as a skin flora contaminant. Literature review reveals that this infection may be underdiagnosed and underreported. Prompt diagnosis may lead to timely initiation of antibiotics which can help prevent devastating complications like constrictive pericarditis. Prospective studies are needed to evaluate the true incidence and prevalence of this disease.
Highlights
Infectious pericarditis remains a very critical diagnosis, and many infectious organisms can be the culprits
No limitations were made on year of publication, age, or country of origin. e search strategy consisted of two concepts. e first concept regarding Cutibacterium acnes was searched using MeSH terms and keywords for the following: Propionibacterium acnes, Cutibacterium acnes, Propionibacterium, cutibacterium, C Acnes, and P acnes
Inflammation alone can cause pericardial effusion and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine has been the cornerstone in the treatment of patients with acute or recurrent viral or idiopathic pericarditis. at being the case, we cannot exclude the presence of mere inflammation in the pericardial tissue in patients with pyogenic pericarditis [41, 42]
Summary
Infectious pericarditis remains a very critical diagnosis, and many infectious organisms can be the culprits. E incidence of pericarditis caused by C. acnes has been increasing worldwide with scarce literature reported on the matter. C. acnes is a slowly growing Gram-positive microaerophilic rod that requires no less than 7 days to grow in culture. In this manuscript, we report Cutibacterium acnes infection in an adult with pericarditis and present an updated comprehensive review of C. acnes causing pericarditis. Articles were included if they were published in the English language and reported on the incidence or prevalence of Cutibacterium acnes in patients with pericardial effusion or pericarditis. As for the second concept, it was searched using the following MeSH terms and keywords: pericardial effusion, effusion, pericarditis, and tamponade.
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