Primary Meningococcal Pericarditis

Abstract

Primary meningococcal pericarditis (PMP) is a purulent pericarditis that can rapidly progress to complications, including cardiac tamponade, pericardial constriction, and need for surgical intervention. Risk factors associated with such complications are not well characterized. We describe a case of PMP and analyze all reported cases of PMP to determine whether certain risk factors lead to the development of cardiac tamponade, pericardial constriction, and need for surgical intervention. Twenty-six cases of PMP were identified, of which 23 (88%) developed tamponade, 7 (27%) constriction, and 7 (27%) need for surgical intervention. A positive pericardial fluid culture was associated with the development of tamponade, whereas a delay in antibiotic initiation, more than 24 hours after chest pain onset, was associated with development of constriction and the need for surgical intervention. All cases of constriction required surgical intervention. Early antibiotic administration appears to protect against the development of constriction and subsequent need for surgery.