Pyopericardium followed by constrictive pericarditis due to Corynebacterium diphtheriae

Abstract

Pyopericardium is a rare entity associated with a high mortality. We report a case of a 44-year old man presenting with simultaneous constrictive pericarditis and pyopericardium due to Corynebacterium diphtheriae. Pericardiectomy and epicardiectomy were performed without cardiopulmonary bypass, with an excellent result.

Pyopericardium progressing to tamponade in a patient with immune thrombocytopenia

“…Electrocardigraphy findings in pericardial effusion are subtle, insensitive and nonspecific, and the presence of ST segment elevation is suggestive of pericarditis 9 10. CT and MRI of thorax also aid in the diagnosis 3. Clinically, Beck’s triad comprising hypotension with narrow or weak pulse pressure, muffled heart sounds and raised jugular venous pressure is indicative of cardiac tamponade.…”

The unmasking of a pyopericardium

“…ST elevation on an ECG may indicate pericarditis, but diagnosis is mostly made after an ECHO followed by aspiration of pus from the pericardial space 5. Other imaging such as CT and MRI can be used to aid diagnosis 1. The condition generally presents with fever, chest pain, congestive cardiac failure, (pulsus paradoxus may be present indicating tamponade), and later with sepsis and cardiogenic shock 5.…”

“…More rare causes include perivalvular abscess rupture in endocarditis and spread along fascial planes from the oral cavity 1 5 6. Factors that can predispose to pericarditis include immunosuppression, alcohol abuse and previous pericardial inflammation and fibrosis 5 6.…”

“…There is also literature that states that an epicardectomy may also be performed in order to liberate movement of the myocardium 1. The ‘turtle cage’ technique has also been suggested as an alternative to epicardectomy, in which slits are made in the epicardium to allow movement of the fibrotic sections 12.…”

“…Since the advent of antibiotics, pyopericardium is a rare phenomenon 1. It has a high mortality rate of 40% in treated patients, and near 100% in untreated patients, therefore it is important not to miss the diagnosis 2 3.…”