Rapidly Developing Methicillin-Resistant Staphylococcus Aureus Pericarditis and Pericardial Tamponade.

Laith Ali,Brian Cuneo,Tariq Sallam,Amre Ghazzal

doi:10.7759/cureus.8001

Laith Ali, Brian Cuneo + Show 2 more

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https://doi.org/10.7759/cureus.8001

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Journal: Cureus	Publication Date: May 7, 2020
Citations: 2	License type: cc-by

Affiliation: MedStar Washington Hospital Center

Abstract

Methicillin-resistant staphylococcus aureus (MRSA) pericarditis is a rare life-threatening infection. A 46-year-old female with hypertension, acquired immunodeficiency syndrome (AIDS) and recurrent neck abscesses, presented with a neck abscess and sepsis. Bloody purulent drainage from the abscess was found and antibiotics were started. Drainage was positive for MRSA. Four days after, course was complicated by acute pericarditis and pericardial tamponade; pericardial fluid was drained and was positive for MRSA. Vancomycin was continued, and aspirin and colchicine were started. Two days later, there was a recurrent pericardial fluid collection with loculation. Surgery was thought to be dangerous in the setting of CD4 count of 12. She was managed conservatively thereafter, with vancomycin, aspirin and colchicine, and was successfully discharged from the hospital.

Highlights

The pericardium is a fibroelastic sac composed of visceral and parietal layers separated by a potential space, the pericardial cavity, which can normally have up to 50 mL of fluid
Acute pericarditis is an inflammation of the pericardium
We report a case of a rapidly developing Methicillin-resistant staphylococcus aureus (MRSA) pericarditis and tamponade in a patient with acquired immune deficiency syndrome (AIDS)

Summary

Introduction

The pericardium is a fibroelastic sac composed of visceral and parietal layers separated by a potential space, the pericardial cavity, which can normally have up to 50 mL of fluid. Acute pericarditis is an inflammation of the pericardium It has been reported in 0.1%-0.2% of hospitalized patients, and 5% of patients presenting to the emergency department with a nonischemic chest pain [1,2]. Chest CT without intravenous contrast (Figure 2, Panel C) showed mild pericardial effusion, but was unremarkable otherwise. Four days later, she developed an acute hypoxic respiratory failure and had increased oxygen requirements reaching 8 L of oxygen-mask, and she was transferred to the medical intensive care unit (MICU). CT chest with intravenous contrast obtained (six days after initial CT, Figure 2, Panel F) showed an expanding pericardial effusion, and mild pleural effusion, but was negative for PE. Thereafter, with six weeks of vancomycin, aspirin and colchicine

Discussion

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Disclosures

Findings

Spodick DH