Patient with Small Cell Lung Carcinoma and Suspected Right Upper Lobe Abscess Presenting with a Purulent Pericardial Effusion

Abstract

Patient: Male, 61Final Diagnosis: Streptococcus pneumoniae pericarditisSymptoms: —Medication: —Clinical Procedure: PericardiocentesisSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Cardiac tamponade caused by pericardial effusion has a high mortality rate; thus, it is important to diagnose and treat this condition immediately. Specifically, bacterial pericarditis, although now very rare, is often fatal because of its fulminant process.Case Report:We present a case of a 61-year-old man with metastatic small cell lung cancer undergoing chemotherapy who presented with fatigue, poor appetite, and altered mental status. He was found to have a large-volume pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis. The pericardial effusion was nonmalignant, with cultures growing Streptococcus pneumoniae. It was only after his emergent pericardiocentesis that previous imaging from one month prior was able to be reviewed, which showed possible right upper lobe abscess.Conclusions:Most pericardial effusions in cancer patients are related to their malignancy, either due to direct metastasis or secondary physiologic effects. This case is a unique example of a lung cancer patient presenting with a pneumococcal pericardial effusion, which in itself is a rare phenomenon. This case report demonstrates the importance of considering early antibiotic therapy in patients presenting with pericardial effusion, especially given the high mortality rates of infectious pericardial effusions.

“A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy

“…Mechanisms of pericardial infection include direct spread from lung, pleura, or mediastinum or hematogenous spread, and Streptococcus and Staphylococcus species are the most common responsible. This disorder is associated with a high mortality rate, usually due to cardiac tamponade as a complication [ 2 ] . This patient’s situation appears to be an exceptionally rare case of pericardial infection caused by what we believe to be a pericardial-mediastinal mass fistula, which developed after radiotherapy sensitization and necrosis of the adenopathic conglomerate and presented acutely as a STEMI.…”

“…Pericardial effusion occurs in 5–15% of all neoplasms, with primary lung cancer being the most common cause [ 4 ] . Furthermore, the most common cause of pericardial effusion in a patient with lung cancer is malignant pericardial effusion [ 2 ] , but this case presents a rarer combination of a patient with primary lung cancer who presents with a nonmalignant, infectious pericardial effusion caused by pneumococcus, as a complication of radiotherapy. Cases of metastatic cardiac tamponade mimicking STEMI have been described [ 5 ] .…”

“…Purulent pericarditis is a rare condition that occurs most commonly from adjacent intrathoracic lesions. Cardiac tamponade caused by pericardial effusion has a high mortality rate; thus, it is important to diagnose and treat this condition as soon as possible [ 2 ] . Clinical suspicion and a rapid analysis of the case are of the utmost importance for proper and adequate treatment, not only in the emergency room but also in the inpatient setting.…”

Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report

“…Pneumococcal pericarditis still carries a high mortality. Where invariably fatal if left untreated, mortality rates are estimated to be 15–40% [ 2 , 13 , 14 ] even with aggressive therapy with drainage and high-dose intravenous antibiotics. The prognosis is poor not only because it usually develops in the context of an already severe infection, but also because the clinical diagnosis is challenging to make and, thus, often delayed.…”