The unmasking of a pyopericardium

Abstract

Pyopericardium is a rare condition with a high mortality rate in which infection propagates in the pericardial space, leading to a pus filled pericardial effusion and cardiac tamponade, which can cause cardiogenic shock and death. We present a case of a previously healthy woman of 52, who was admitted with a severe lower respiratory tract infection that eventually led to a pyopericardium. The diagnosis of pyopericardium was delayed due to masking of symptoms by her underlying infection, sepsis and an upper gastrointestinal bleed that the patient suffered during the admission, requiring an emergency gastroscopy. The pyopericardium was considered when ST elevation was seen on an ECG and an ECHO discovered a large pericardial effusion causing tamponade. An emergency pericardiocentesis drained frank pus. Treatment with intravenous antibiotics, frequent pericardial drainage and a pericardectomy led to an excellent outcome, and a full recovery.

Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

“…Immunosuppression, alcohol abuse and previous pericardial inflammation can cause pyopericardium 4. In our case, the patient was an elderly man with diabetes mellitus and history of heavy smoking.…”

Pyopericardium presenting as pericardial tamponade in a patient with common variable immunodeficiency disorder

“…Pyopericardium, or purulent pericarditis, is rare and rapidly fatal if left untreated. In treated patients, it has a mortality rate of up to 40%, related to cardiac tamponade and constriction 8–11 13–17. Pyopericardium can be caused by contiguous dissemination from pneumonia or empyema, by haematogenous spread, during cardiac or thoracic surgery or trauma 11 13 14.…”

A Disastrous Omen – Candidal Pyo pneumopericardium

“…Pyo-pneumopericardium is a rare medical condition where an infection propagates in the pericardial sac, leading to a pus-filled pericardial effusion and cardiac tamponade, that can cause cardiogenic shock and even death. [ 1 2 3 ] It is diagnosed when pus is drained directly from the pericardial space or when bacteria or fungi are cultured from the pericardial fluid. The majority of the reported cases are due to direct spread from pneumonia or empyema, however thoracic surgery, direct hematogenous spread and trauma can also cause the same.…”

“…Computed tomography (CT) or magnetic resonant imaging (MRI) may aid the diagnosis as they can simultaneously show anatomical abnormalities of lung and mediastinal structures with better soft-tissue contrast and larger field of vision than a 2D-Echo. [ 1 9 10 ] Literature review demonstrated that Hemophilus influenza, Staphylococcus aureus , Viridans streptococci, Streptococcus pneumoniae and anaerobic bacteria to be the most common causative agent. However, few reports showed that gram-negative bacteria and fungi to be more frequent in immunocompromised hosts while others showed gram-positive coccis as the most commonly isolated organisms.…”

“…In the present antibiotic era, pyo-pneumopericardium is uncommon however, fatal as can cause death due to cardiac tamponade and cardiogenic shock. [ 1 2 ] Several etiological agents like Staphylococcus aureus , Streptococcus spp., Hemophilus influenzae, Pseudomonas spp., coliforms, and anaerobic bacteria have been implicated. [ 3 4 ] The growth of yeast (Candida sp.)…”