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Katahira R, Sano H, Tanimura K, Okita Y. Cardiac rupture during the course of treatment for acute purulent pericarditis caused by Staphylococcus aureus: a case report. Eur Heart J Case Rep 2023; 7:ytad584. [PMID: 38025118 PMCID: PMC10681738 DOI: 10.1093/ehjcr/ytad584] [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] [Received: 01/07/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
Background Purulent pericarditis is rare in the modern era of antibiotics. However, it is a rapidly progressive, life-threatening disease with complications, including cardiac tamponade and left ventricular pseudoaneurysm. Case summary A 44-year-old female was admitted with a pontine haemorrhage. On the 25th day of admission, she developed a fever along with chest pain and dyspnoea. Transthoracic echocardiography and computed tomography revealed a large pericardial effusion, leading to the diagnosis of cardiac tamponade. Pericardiocentesis was performed, resulting in the drainage of 750 mL of blood-stained fluid. Blood and pericardial fluid cultures were positive for Staphylococcus aureus; therefore, ceftriaxone was administered. On the 49th day, she became febrile again, and computed tomography showed increased pericardial effusion. Transthoracic echocardiography confirmed the large pericardial effusion and revealed a pseudoaneurysm on the inferior of the left ventricular wall, with blood flowing from the pseudoaneurysm into the pericardial space. Urgent surgical intervention was performed to repair a myocardial defect as a left ventricular pseudoaneurysm had ruptured in the pericardium. The patient recovered and was transferred to another hospital for rehabilitation after 108 days of hospitalization. Discussion Purulent pericarditis can be a lethal complication; therefore, careful follow-up and strict adherence to therapeutic strategies, including the use of imaging technologies such as echocardiography, are important.
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Affiliation(s)
- Ryutaro Katahira
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Hiroyuki Sano
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Kosuke Tanimura
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Yutaka Okita
- Division of Cardio-Aortic Center, Department of Surgery, Takatsuki General Hospital, Takatsuki, Japan
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Arun Kumar P, Patel B, Dasari M, Arun Kumar S, Shah N, Laidlaw D. Aseptic presentation of interventricular septal abscess with progressive heart block: a case report. J Med Case Rep 2023; 17:131. [PMID: 37032324 PMCID: PMC10084690 DOI: 10.1186/s13256-023-03846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/26/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Infective endocarditis can progress to an intracardiac abscess in 20% to 30% of cases, with interventricular septal abscess (IVSA) being one of the rare complications usually presenting with sepsis. We present a case of IVSA presenting with a new-onset second-degree heart block, which rapidly progressed to a complete heart block. CASE PRESENTATION A 80-year-old Caucasian female with a past medical history of hypertension and hyperlipidemia presented with exertional chest pain, lightheadedness, and shortness of breath with telemetry and electrocardiogram revealing persistent Mobitz type II second degree atrioventricular block. The rest of the vitals were normal. As she was being planned for a pacemaker placement, she spiked a temperature of 103F. Blood cultures grew methicillin-sensitive Staphylococcus aureus, and appropriate antibiotics were initiated. Transthoracic echocardiogram was grossly normal. However, transesophageal echocardiogram revealed a heterogeneous extension of an echodensity from the aortic root, along the aorto-mitral cushion and into the interventricular septum, indicating an interventricular septal abscess. Her course was complicated by altered mental status, with computed tomography of the brain revealing hypodense regions in the left lentiform nucleus and anterior caudate nucleus representing acute/subacute stroke. Surgery was deferred as she was deemed a poor candidate. She succumbed to her illness on day 6 of hospitalization. CONCLUSION Intracardiac abscesses should be considered a possible initial differential in patients with progressive heart block despite aseptic presentation and no risk factors.
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Affiliation(s)
- Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA.
| | - Boskey Patel
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Sumukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - Neeta Shah
- Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Douglas Laidlaw
- Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Clinical Presentation and Management of Methicillin-Resistant Staphylococcus aureus Pericarditis—Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9040103. [PMID: 35448079 PMCID: PMC9024581 DOI: 10.3390/jcdd9040103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/13/2022] Open
Abstract
In the expanding era of antibiotic resistance, new strains of Staphylococcus aureus have emerged which possess resistance to traditionally used antibiotics (MRSA). Our review aimed to systematically synthesize information on previously described MRSA pericarditis cases. The only criterion for inclusion was the isolation of MRSA from the pericardial space. Our review included 30 adult and 9 pediatric patients (aged: 7 months to 78 years). Comorbid conditions were seen in most adult patients, whereas no comorbidities were noted amongst the pediatric patients. Pericardial effusion was found in 94.9% of cases, with evidence of tamponade in 83.8%. All cases isolated MRSA from pericardial fluid and 25 cases (64.1%) had positive blood cultures for MRSA. Pericardiocentesis and antibiotics were used in all patients. The mortality rate amongst adults was 20.5%, with a mean survival of 21.8 days, and attributed to multi-organ failure associated with septic shock. No mortality was observed in the pediatric population. In adult patients, there was no statistical difference in symptom duration, antibiotic duration, presence of tamponade, age, and sex in relation to survival. Conclusion: MRSA pericarditis often presents with sepsis and is associated with significant mortality. As such, a high clinical suspicion is needed to proceed with proper tests such as echocardiography and pericardiocentesis. In more than one third of the cases, MRSA pericarditis occurs even in the absence of documented bacteremia.
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Aljassim NA, Almashraki N, Tageldein M, Tamimi O, Kabbani MS, Zahraa J, Alshehri M. Complicated community-acquired methicillin-resistant Staphylococcus aureus pancarditis with cardiac pseudoaneurysm in a healthy child: A case report. Int J Surg Case Rep 2020; 77:71-75. [PMID: 33157337 PMCID: PMC7644799 DOI: 10.1016/j.ijscr.2020.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines. PRESENTATION OF CASE We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit. DISCUSSION Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes. CONCLUSION Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.
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Affiliation(s)
- Nada A Aljassim
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Nabeel Almashraki
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohamed Tageldein
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Omer Tamimi
- Department of Pediatrics Cardiology, King Salman Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Mohamed S Kabbani
- Department of Cardiac Sciences, Division of Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, Ministry of National Guard, P.O. Box: 22490, Riyadh, 11426, Saudi Arabia.
| | - Jihad Zahraa
- Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Mohammed Alshehri
- Department of Pediatrics Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
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Larrieu-Ardilouze E, Christiaens L, Varroud-Vial N, Madico C, Hajj-Chahine J, Rehman MB. Pancarditis: an unusual complication of a group B streptococcal infection. Acta Clin Belg 2018; 73:156-161. [PMID: 28659007 DOI: 10.1080/17843286.2017.1339481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. Diagnosis is often delayed and the clinical signs are predominantly those of the embolic complications. Literature is scarce. We present a unique and rare case of pancarditis, complicating a Streptococcal B infection in an immunocompetent, healthy, 54 year-old woman. The evolution was favourable under medical therapy alone and thanks to multimodality cardiac imaging diagnosis and follow-up.
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Affiliation(s)
- Elisa Larrieu-Ardilouze
- Department of Cardiology and Vascular Diseases, Poitiers University Hospital, Poitiers, France
| | - Luc Christiaens
- Department of Cardiology and Vascular Diseases, Poitiers University Hospital, Poitiers, France
| | - Nicolas Varroud-Vial
- Department of Cardiology and Vascular Diseases, Poitiers University Hospital, Poitiers, France
| | - Coralie Madico
- Department of Radiology, Poitiers University Hospital, Poitiers, France
| | - Jamil Hajj-Chahine
- Department of Cardiology and Vascular Diseases, Poitiers University Hospital, Poitiers, France
| | - Michaela B. Rehman
- Department of Cardiology and Vascular Diseases, Poitiers University Hospital, Poitiers, France
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Sanchez J, Schneider A, Tretter JT, Shopsin B, Al-Qaqaa Y, Khaitan A, Chadha T. Community-Acquired MRSA Pericarditis and Mediastinitis in a Previously Healthy Infant. J Pediatr Intensive Care 2017; 7:97-101. [PMID: 31073479 DOI: 10.1055/s-0037-1607325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022] Open
Abstract
Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections disproportionately affect children, but there are few pediatric reports of pericarditis and mediastinitis caused by CA-MRSA in previously healthy children. Here we report a severe case of CA-MRSA pericarditis with extension to the mediastinum and carotid sheath in a previously healthy 8-month-old infant who was successfully treated with surgical interventions and with a combination of daptomycin and vancomycin. The relatively indolent clinical course in this patient was notable given the significant extent of infection. This case highlights the potential virulence of CA-MRSA in previously healthy children and the importance of early diagnosis, prompt drainage, and appropriate antibiotic coverage.
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Affiliation(s)
- Joselito Sanchez
- Division of Infectious Diseases and Immunology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Amanda Schneider
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Justin T Tretter
- Division of Cardiology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Bo Shopsin
- Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, New York
| | - Yasir Al-Qaqaa
- Division of Critical Care, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Alka Khaitan
- Division of Infectious Diseases and Immunology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Tanya Chadha
- Division of Critical Care, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
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