Abstract
Purulent pericarditis is a potentially fatal disease with high mortality rates if untreated. Cutibacterium acnes (formerly Propionibacterium acnes) is an anaerobic bacteria that is ubiquitous in skin flora and is commonly thought of as a culture contaminant; however, it does have pathogenic potential. We present a case of purulent pericarditis secondary to C. acnes leading to cardiac tamponade. Initial stabilization and diagnosis were made via pericardiocentesis; afterward the patient underwent a pericardial window. Due to a severe penicillin allergy, he was successfully treated with a 14-day course of vancomycin. To our knowledge, this represents only the third published case of purulent pericarditis with cardiac tamponade caused by C. acnes and the first case treated with a 14-day course of vancomycin.
Highlights
Purulent pericarditis is a rare subset of bacterial pericarditis that is characterized by gross or microscopic purulence in the pericardium and most commonly develops from direct contiguous spread of an intrathoracic infection or intracardiac source and less commonly via hematogenous spread
Purulent pericarditis presents with fever, dyspnea, and tachycardia, with a median time from symptom onset to presentation of seven days
Clinicians must have a high index of suspicion as it infrequently presents with the classic features of acute pericarditis such as pericardial chest pain, electrical alternans, and a pericardial friction rub, all of which were absent in this case
Summary
Purulent pericarditis is a rare subset of bacterial pericarditis that is characterized by gross or microscopic purulence in the pericardium and most commonly develops from direct contiguous spread of an intrathoracic infection (such as pneumonia or mediastinitis) or intracardiac source and less commonly via hematogenous spread. Prior to World War II, purulent pericarditis was a fairly common disease with an incidence as high as 1 in 254 persons. Despite decreasing incidence and improved antimicrobials, purulent pericarditis remains an important cause of morbidity and mortality as it is rapidly progressive and highly fatal if left untreated [1, 2]. Several known complications of purulent pericarditis are reported to include cardiac tamponade, constrictive pericarditis, left ventricular pseudoaneurysm, and aortic mycotic aneurysm formation, among others [1,2,3]. The severity of these complications makes a high index of suspicion imperative to allow prompt diagnosis and treatment
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