Purulent pericarditis in a patient with Turner`s syndrome

Abstract

Introduction: Turner`s syndrome(TS), also known as 45,X is a genetic disorder where a female is part­ly or completely missing one of the X chromosomes. TS is characterized with low levels of estrogen and increased risk of a lot of disorders, with cardiac conditions being one of the most serious. Re­searches show that TS might be related to decreased levels of circulating T and B lymphocytes and re­duced levels of serum immunoglobulin G and immunoglobulin M, in this way making the patients more susceptible to infections. The aim of this case report is to underline the acute inflammatory process caused by Staphylococcus aureus that developed as a comorbidity to a rare genetic condition. Materials and methods: We present a case of a 23-year-old woman with complaints of acute chest pain, drowsiness, fever up to 38 degrees oC and an episode of collapse without loss of conscious­ness. Blood tests showed high levels of leucocytes, erythrocyte sedimentation rate and C-reactive pro­tein which confirmed the presence of an infection. A massive pericardial effusion was detected dur­ing echocardiography. It was drained and the microbiological analysis revealed Staphylococcus au­reus as a major cause. During electrocardiography diffuse repolarisation abnormalities were found. A few consecutive chest X-rays revealed growing pleural effusions which were confirmed by the fol­lowing computed tomography scan and positron emission tomography/computed tomography. In ad­dition the pericardium turned out to be diffusely thickened with the presence of atelectasis and sple­nomegaly. Results: The treatment included drainage of the effusions, corticosteroids and a combination of an­tibiotics (Clindamycin, Levofloxacin, Ciprofloxacin, Metronidazole) aiming to eradicate the bacte­ria and alleviate the symptoms. Conclusion: In this era of antibiotic treatment, purulent pericarditis caused by S. aureus is an ex­tremely rare condition. Its development on the background of TS makes it unique and interesting.