A Aziz, W Jafri, TA Jawed, A Shaikh, B Farooqui, MK Ashfaq, N Ul Haq, Salmonella Hadar Pericarditis. 1993; 13(1): 85-87 Acute purulent pericarditis is an infrequent but potentially life-threatening disease. Early and effective treatment requires a knowledge not only of the clinical course but also of the organisms commonly responsible. However, unusual microbes may be incriminated in immunocompromised hosts. We report a case of Salmonella hadar pericarditis in a female with systemic lupus erythematosus (SLE) being treated with oral steroids. Although other non-typhoidal Salmonella species have previously been implicated in the causation of bacterial pericarditis [1][2][3][4][5][6][7][8][9], infection of the pericardium with this species of Salmonella has not previously been reported.
Case ReportA 28-year-old female diagnosed to be suffering from systemic lupus erythematosus over six months preceding a current illness and maintained on prednisolone 10 mg daily was admitted to the Aga Khan University Hospital, Karachi, Pakistan, with a one-month history of low grade fever and progressive dyspnea on exertion leading to acute exacerbation of dyspnea over three hours prior to presentation. Systemic review was unremarkable. In particular, there was no history of fever, chest pain, cough or expectoration, bowel symptoms or recent procedures of any kind.On examination, she was tachypneic with respiratory rate of 30 per min, and had a blood pressure of 100/90 mm Hg with a 10 mm drop in systolic pressure during inspiration. Her temperature was 39°C and a heart rate of 88 per minute. Pulse was of low volume. Internal jugular veins were distended to the angle of the jaw in sitting position and she had cushingoid facies. Apex beat was not palpable and heart sounds were reduced in intensity. There was no pericardial rub. Chest was clear on auscultation and liver span was 10 cm in the right mid-clavicular line. The remainder of the examination was unremarkable except for a malar rash and trace pedal edema.Total leucocyte count was 10.9 × 10 9 /L with 84% polymorphonuclear leukocytes. Erythrocyte sedimentation rate was 63 mm in the first hour by Westergren method. ECG showed low voltage and sinus tachycardia. Chest xray showed an enlarged cardiac silhouette. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was performed and 1200 ml of thick purulent fluid was removed. On analysis, this pericardial fluid was exudative with a total leucocyte count of 59,000/ml of which 85% were polymorphonuclear leukocytes. Gram-stain revealed gram negative bacilli. The fluid was cultured on blood agar, chocolate agar, and Mac Conkey agar and incubated aerobically and anaerobically.Salmonella species was isolated from this pericardial fluid and later sent to the Central Public Health Laboratory in Collindale, London, England, where it was typed as Salmonella hadar phage type 2 which belongs to the non-typhoidal salmonella group C 2 . Blood, collected prior to antibiotic therapy, was culture-negative following incubat...
