SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bacterial pericarditis with cardiac tamponade due purulent pericardial effusion is rare in the modern antibiotic era. It is a rapidly progressive and highly fatal infection and is often diagnosed postmortem in majority of the cases. We present a case of purulent pericardial effusion due to streptococcus pneumoniae in an immunocompromised patient with PLAID (PLCG2 associated antibody deficiency and immune dysregulation) syndrome. PLAID is a complex dominantly inherited disease, characterized almost universally by cold urticaria, autoimmunity and skin granuloma formation. CASE PRESENTATION: A 28-year-old male, with past medical history significant for PLAID syndrome associated with cutaneous malignancies and asthma presented with a weeklong history of increased cough with productive sputum and pleuritic chest pain. Upon admission, he was hemodynamically stable except for tachycardia and exam showed muffled heart sounds and crackles at left lung base. Labs were significant for leukocytosis of 45,000 and CXR showed left lower lobe opacity consistent with pneumonia. He was therefore started on antibiotics but since he continued to deteriorate clinically, CT scan was ordered which revealed bilateral multifocal pneumonia, a large multiloculated left pleural effusion, and a large pericardial effusion. A subsequent echocardiogram in conjunction with physical exam findings of pulsus paradoxus of 28mm of Hg was consistent with early tamponade physiology, and the patient underwent an uncomplicated sub-xiphoid pericardial window with placement of drain. Chest tube was placed for left posterior pleural effusion. Pleural fluid and blood, and pericardial fluid cultures grew Streptococcus pneumonia. The pericardial drain was removed. The patient eventually had a pulmonary decortication of the lung tissue secondary to dense, copious adhesions and has recovered well. DISCUSSION: Purulent pericarditis, especially from streptococcus pneumonia is a rare entity in the developed world. Following the introduction of antibiotics and more recently the pneumococcal-conjugate vaccine, the incidence of bacterial pericarditis from streptococcus pneumonia has drastically decreased. Diagnosis is therefore challenging due to low clinical suspicion. It generally presents with acute cardiovascular decompensation and a sepsis-like appearance. Our case was unique as initial course of illness was indolent, which could be related to patients immunodeficiency. If untreated, this condition has a mortality rate of up to 100%. CONCLUSIONS: Purulent pericarditis secondary to streptococcus pneumoniae is rare, however, a high index of suspicion is needed for early diagnosis to instate appropriate therapy with drainage and antibiotics given the risk of life-threatening tamponade. Reference #1: J. Sagrista-Sauleda, J.A. Barrabes, G. Permanyer-Miralda, J. Soler-SolerPurulent pericarditis: review of a 20 year experience in a general hospitalJ Am Coll Cardiol, 22 (1993), pp. 1661-1665 DISCLOSURES: No relevant relationships by Timothy Ford, source=Admin input No relevant relationships by Sriharsha Gowtham, source=Web Response No relevant relationships by adithya kattamanchi, source=Web Response No relevant relationships by Saptak Pandita, source=Web Response No relevant relationships by Vikrant Tambe, source=Web Response