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Christian-Miller N, Goraya S, O'Hayer P, Albin O, Nicklas J. Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Review. Cureus 2024; 16:e62626. [PMID: 39027746 PMCID: PMC11257658 DOI: 10.7759/cureus.62626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Purulent pericarditis is a rare and potentially life-threatening condition characterized by infection of the pericardial space. We describe a case of purulent bacterial pericarditis in a 41-year-old male with no significant medical or surgical history who had concomitant pulmonary Histoplasma infection. Streptococcus intermedius was the bacteria directly responsible for the pericardial infection, though co-infection with histoplasmosis likely predisposed him to develop purulent pericarditis. We hypothesize histoplasmosis caused mediastinal lymphadenopathy, facilitating contact between a necrotic lymph node and the pericardium and contiguous suppuration of bacteria to the pericardial space. We treated S. intermedius and Histoplasma capsulatum with ceftriaxone and amphotericin B, respectively. Additionally, the patient presented in cardiac tamponade requiring emergent pericardiocentesis and drain placement. His course was also complicated by pericardial constriction. Cardiac magnetic resonance confirmed this, showing inflamed pericardium and abnormal septal motion with inspiration, and he had symptoms refractory to antimicrobials and anti-inflammatories. As such, he required pericardiectomy. This case demonstrates maintaining suspicion for secondary infectious foci as a contributor to the pathogenesis of purulent pericarditis is important, as pulmonary histoplasmosis played a pivotal role in allowing S. intermedius to spread to the pericardium but was not the primary infection. It also highlights the multifaceted evaluation and management of purulent pericarditis, highlighting the role of echocardiography and emergent pericardial drainage if cardiac tamponade is present, the importance of targeted antimicrobial therapy, the superior ability of cardiac magnetic resonance to identify pericardial constriction as a sequela of purulent pericarditis, and indications for pericardiectomy.
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Affiliation(s)
| | - Sayhaan Goraya
- Internal Medicine, University of Michigan Hospitals, Ann Arbor, USA
| | - Patrick O'Hayer
- Cardiology, University of Michigan Hospitals, Ann Arbor, USA
| | - Owen Albin
- Infectious Disease, University of Michigan Hospitals, Ann Arbor, USA
| | - John Nicklas
- Cardiology, University of Michigan Hospitals, Ann Arbor, USA
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Huang M, Li S, Wu X, Xu D, Tang L, Chen Z. An isolated pulmonary nodule secondary to Streptococcus intermedius infection in an otherwise healthy 10-year-old boy: A case report and literature review. Front Pediatr 2022; 10:921258. [PMID: 36160793 PMCID: PMC9490049 DOI: 10.3389/fped.2022.921258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Streptococcus intermedius, as a Gram-positive commensal bacterium, tends to cause various infections, such as brain and liver abscesses, endocarditis, and empyema, especially in immunocompromised patients. However, an isolated pulmonary nodule caused by S. intermedius in previously healthy individuals without traditional risk factors is rarely reported. Herein, we present a case of a 10-year-old immunocompetent boy referred to our department with a 5-day history of intermittent, left-sided chest pain. Chest X-ray and computed tomography revealed a left lung nodule. Although his blood, sputum, and bronchoalveolar lavage fluid cultures were negative, metagenomic next-generation sequencing (mNGS) showed only the presence of S. intermedius in ultrasonography-guided lung biopsy tissue and pleural fluid (416 and 110 reads, respectively). He was then successfully treated with appropriate intravenous antibiotics and avoided surgical intervention. To the best of our knowledge, this is the first report of S. intermedius-related pulmonary nodule confirmed by mNGS analysis in healthy children. For achieving proper diagnosis and treatment, infection with S. intermedius should be included in the differential diagnosis when coming across such a similar pulmonary nodule. mNGS, as a valuable supplement to conventional culture methods, is an essential diagnostic tool for identifying pathogens without typical characteristics.
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Affiliation(s)
- Meixia Huang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiling Wu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dan Xu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lanfang Tang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Khan MS, Khan Z, Banglore BS, Alkhoury G, Murphy L, Georgescu C. Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report. J Med Case Rep 2018; 12:27. [PMID: 29397796 PMCID: PMC5798186 DOI: 10.1186/s13256-018-1570-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Acute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions. Case presentation A 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery. Conclusions Acute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.
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Affiliation(s)
- Mohammad Saud Khan
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA.
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA
| | - Bhavana Siddegowda Banglore
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA.,Department of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ghattas Alkhoury
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA
| | - Laura Murphy
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA.,Department of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Claudiu Georgescu
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1150, Toledo, Ohio, 43614, USA.,Department of Infectious Diseases, University of Toledo Medical Center, Toledo, Ohio, USA
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