SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary meningococcal pericarditis (PMP) is a rare form of purulent pericarditis that can occur in the event of N. Meningitidis bacteremia without meningitis or fulminant septicemia. This form of pericarditis can be infectious or immunologic and in either form, can cause life threatening tamponade (1). Here described is a case of rapidly evolving purulent pericarditis and pleural effusion in a patient with meningococcal bacteremia. CASE PRESENTATION: A 56 year old male with a history of HIV, and remote bacterial meningitis presented with pleuritic chest pain, worsened in the supine position, fevers, and diaphoresis. At the initial time of presentation ECG findings were consistent with pericarditis and bedside echo showed minimal pericardial effusion. The patient was evaluated and due to persistent hypotension, was admitted to the MICU. Hours after admission, the patient developed worsened chest pain, in the setting of continued hypotension. A bedside echo and CTPE showed increasing pericardial effusion with tamponade physiology, as well as small developing pleural effusions. Urgent pericardiocentesis was performed, 350mL of purulent fluid was obtained and a pericardial drain placed. Pericardial fluid cultures were negative, but blood cultures grew Neisseria meningitidis. Antibiotics were deescalated from piperacillin-tazobactam to ceftriaxone at that time. Serial bedside ultrasounds and showed a on hospital day three showed rapidly increasing pleural effusions despite pericardial drain placement. A right sided diagnostic thoracentesis was performed that was exudative by Lights Criteria and class 2 with a pH 7.45 and glucose 177. The following day, left sided thoracentesis was performed, and the patient had improvement in his hypoxia and symptomatology. He was discharged home to complete a 14 day course of ceftriaxone. DISCUSSION: The most common forms of invasive meningococcal disease are septicemia and meningitis. Approximately 10% of the population is a carrier of N. menigitidis, but invasive disease is relatively rare (2). Other sites of involvement are less common, but pericarditis has been reported in meningococcal bacteremia. This most often occurs in the presence of meningococcal meningitis or fulminant septicemia (3). This patient had no signs of meningitis or fulminant sepsis at the time of presentation. Rapid accumulation of purulent fluid causing cardiac tamponade has been described in PMP (4). CONCLUSIONS: Primary meningococcal pericarditis is a remarkably unusual presentation of meningococcal disease. Rapid progression to tamponade physiology can develop in these patients and monitoring for signs of pericarditis in patients with meningococcal disease should be implemented. Reference #1: Pericarditis as a complication of meningococcal meningitis. Morse JR, Oretsky MI, Hudson JA, Ann Intern Med. 1971;74(2):212. Reference #2: Update on meningococcal disease with emphasis on pathogenesis and clinical management. van Deuren M, Brandtzaeg P, van der Meer JW. Clin Microbiol Rev. 2000 Jan; 13(1):144-66. Reference #3: Zeidan A, Tariq S, Faltas B, Urban M, McGrody K. A case of primary meningococcal pericarditis caused by Neisseria meningitidis serotype Y with rapid evolution into cardiac tamponade. J Gen Intern Med. 2008;23(9):1532–1535. DISCLOSURES: No relevant relationships by Giovi Grasso-Knight, source=Web Response No relevant relationships by Matthew Schloop, source=Web Response No relevant relationships by Mouhamed Shatila, source=Web Response