METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS-INDUCED PERICARDITIS AND PERICARDIAL TAMPONADE IN AIDS PATIENT: PRESENTATION, PROGRESSION, AND MANAGEMENT

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: We report a case of 46-year old woman with untreated AIDS (CD4 count 12), and recurrent neck abscesses, who presented with a neck abscess, and developed acute pericarditis, which resulted in pericardial effusion and tamponade. Blood, purulent drainage from the abscess, and pericardial fluid cultures were positive for methicillin resistant staphylococcus aureus (MRSA). The patient was successfully treated with 6 weeks of IV Vancomycin, and pericardial drainage. CASE PRESENTATION: The patient is a 46 year old woman with past medical history of AIDS (Most recent CD4 count 12) who was not on anti-retroviral therapy due to social reasons with recurrent skin/soft tissue infections, who presented with fever and chest pain of 1 week duration. She also reported a recurrent anterior neck mass. On hospital admission, her chest pain was constant for the past week, and is worse with movement and deep inspiration. She states the pain is under her left breast and radiates towards her left shoulder. She denies shortness of breath, or lower extremity edema. DISCUSSION: MRSA Pericarditis is a very rare life-threatening infection, with only a few cases reported in literature [1] [2] [3]. Mortality rates for purulent pericarditis were reported to be as high as 40% in the treated population. In immunosuppressed patients or following thoracic surgery, Staphylococcus aureus (30%) and fungi (20%) are more common [10]. CONCLUSIONS: Management of MRSA pericarditis was done through pericardial drain, with some cases treated with pericardial window (Class I recommendation for pericardial window, and Class IIa for subxiphoid pericardiotomy by 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology). Our case was managed by pericardial drainage alone, and although she had recurrence of pericardial effusion, pericardiotomy was felt to be very risky given her AIDS with CD4 count Reference #1: 1) Kurahara, Y. and Kawaguchi, T. Cardiac Tamponade with Community-acquired Methicillin-resistant Staphylococcus aureus Pericarditis. Intern Med. 2013;52(15):1753. Reference #2: 2)Hussam, M., Ragai, M., Iman, M. and Zakaria, A. Community-acquired methicillin-resistant Staphylococcus aureus pericarditis presenting as cardiac tamponade. South Med J. 2010 Aug;103(8):834-6 Reference #3: 3)Oizumi, H., Ichinokawa, H., Hoshino, H., Shitara, J. and Suzuki, K. Pericardial Window for Methicillin-Resistant Staphylococcus aureus Pericarditis. Ann Thorac Surg. 2019 Jan;107(1):e27-e29. DISCLOSURES: No relevant relationships by Laith Ali, source=Web Response No relevant relationships by Brian Cuneo, source=Web Response No relevant relationships by Amre Ghazzal, source=Web Response No relevant relationships by Tariq Sallam, source=Web Response