A case report of pyopneumopericardium following bungee jumping in a patient with tuberculosis

RATIONALE

Pyopneumopericardium related to bungee jumping is a rare occurrence in the current antibiotic era. We present a case of esophagus-seeded Streptococcus sanguinis pyopneumopericardium in a young man with tuberculosis who had just completed bungee jumping.

PATIENT CONCERN

A 27-year-old man was hospitalized with a 1-day history of fever, chest tightness, and intermittent sharp chest pain after bungee jumping for the first time.

DIAGNOSES

Clinical examinations, thoracentesis, and pericardiocentesis revealed pyopneumopericardium, pyopneumomediastinum, and suppurative pleurisy secondary to bungee-jumping-related traumas. Pericardial fluid cultures were positive for S sanguinis, and Mycobacterium tuberculosis complex genetic test was positive in both sputum and pleural effusion.

INTERVENTIONS

The patient improved with drainage and comprehensive antimicrobial therapy.

OUTCOMES

The patient developed constrictive pericarditis and underwent pericardiectomy after 6 months of anti-tuberculosis treatment. During the 6-month follow-up after surgery, he recovered uneventfully.

LESSONS

This case adds to the long list of bungee-jumping complications. Early diagnosis to initiate appropriate therapy is critical for pyopneumopericardium patients to achieve good outcomes.

Pneumopericardium due to invasive pulmonary aspergillosis

We describe a 59-year-old female patient with leukemia who developed pneumopericardium as a complication of invasive pulmonary aspergillosis. Spiral computed tomography (CT) was very helpful for the detection of such complications.

Afebrile spontaneous pneumopyopericardium

A 77-year-old woman had spontaneous pneumopyopericardium caused by Klebsiella pneumoniae. Chest X-ray revealed a horizontal air-fluid level in the cardiac shadow. Echocardiogram showed characteristic spontaneous contrast echoes in the pericardial effusion. She received pericardiectomy and remained in good condition postoperatively.

Complicated pulmonary aspergillosis with pneumothorax and pneumopericardium in a child with acute lymphoblastic leukemia

Invasive aspergillosis is a fungal infection that is being observed increasingly in immunocompromised patients due to the use of more aggressive chemotherapeutic regimens. To our knowledge, no case of pneumothorax and pneumopericardium associated with invasive pulmonary aspergillosis has been reported to date. High-dose amphotericin B (1 to 1.5 mg/kg/day) is the treatment of choice, although severe side effects, especially hypokalemia, are very common. Itraconazole is considered to be a therapeutic alternative for invasive pulmonary aspergillosis in immunocompromised patients. A rare combination of pneumothorax and pneumopericardium associated with systemic aspergillosis in a child with acute lymphoblastic leukemia is described. Treatment with low-dose amphotericin B and itraconazole achieved complete resolution of the foregoing complications.