ABSTRACT

A previously healthy 18-year-old man was admitted with asthenia, fever, shivering, oppressive chest pain, and orthopnea of three-day duration. He had an infected finger wound and lymphangitis on his forearm, self-medicated with topical ointments unsuccessfully. He was febrile (39 ^oC), hypotensive, with low SpO2 and oliguria, without peripheral edema, hepatojugular reflux or pericardial friction rub. He suddenly had jugular distention, muffled heart sounds and paradoxical pulse, indicating cardiac tamponade, further confirmed. Erythrocyte sedimentation rate, neutrophil-lymphocyte count ratio, C-reactive protein, and procalcitonin) were elevated. Despite of intensive care he had irreversible cardiac arrest. Autopsy revealed hemopericardium causing death by cardiac tamponade and pulmonary edema, in addition to fibrinous pericarditis, hepatic abscess, and acute tubular necrosis. Methicillin-resistant Staphylococcus aureus (MRSA) was found in tissue and blood samples. Eventual tuberculosis coinfection and pericardial involvement by malignancy were ruled out. The role of autopsy to better understand mechanisms of cardiac tamponade is commented.

KEYWORDS

Cardiac tamponade, hemopericardium, liver abscess, pericarditis.

REFERENCES

1. Bagavathy K, Raju SK, Joseph R, Kumar A. Cardiac tamponade complicating purulent pericarditis due to community acquired methicilin resistant Staphylococcus aureus (CA-MRSA). Conn Med 2014;78(3):163-165.

2. Bernadette NN, Kamgaing N, Monebenimp F, Simeu C. Human immunodeficiency virus infection in a child revealed by a massive purulent pericarditis mistaken for a liver abscess due to Staphylococcus aureus. Afr J Paediatr Surg 2015;12(1):71-73. doi: 10.4103/0189-6725.150988.

3. Caksen H, Uzüm K, Yüksel S, Basrîüstünbas H, Oztürk MK, Narin N. Cardiac findings in childhood staphylococcal sepsis. Jpn Heart J 2002;43(1):9-11.

4. Dababneh E, Siddique M. Pericarditis. StatPearls. Treasure Island (FL): StatPearls Publishing; 2017.

5. Dionísio MT, António M, Silva PV, et al. Descending necrotizing mediastinitis presenting as cardiac tamponade. Rev Port Cardiol 2011;30(2):243-248.

6. Durão D, Fernandes AP, Marum S, Marcelino P, Mourão L. Cardiac tamponade secondary to methicillin-resistant Staphylococcus aureus pericarditis. Rev Port Cardiol 2008;27(7-8):953-958.

7. Gabler M. Cardiac tamponade secondary to purulent pericarditis diagnosed with the aid of emergency department ultrasound. Am J Emerg Med 2017;2017;35(8):1212.e1-1212.e3. doi: 10.1016/j.ajem.2017.04.068.

8. Gunatilake SS, Yapa LG, Gallala M, Gamlath R, Rodrigo C, Wimalaratna H. Lemierre’s syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report. Int J Emerg Med 2014;7:39. doi: 10.1186/s12245-014-0039-y.

9. Kabukcu M, Demircioglu F, Yanik E, Basarici I, Ersel F. Pericardial tamponade and large pericardial effusions: causal factors and efficacy of percutaneous catheter drainage in 50 patients. Tex Heart Inst J 2004;31(4):398-403.

10. Kurahara Y, Kawaguchi T. Cardiac tamponade with community-acquired methicillin-resistant Staphylococcus aureus pericarditis. Intern Med 2013;52(15):1753.

11. Lee JH, Noh YS, Lee YH, et al. Pleural and pericardial empyema in a patient with continuous ambulatory peritoneal dialysis peritonitis. Korean J Intern Med 2013;28(5):626-627. doi: 10.3904/kjim.2013.28.5.626.

12. Lutmer JE, Yates AR, Bannerman TL, Marcon MJ, Karsies TJ. Purulent pericarditis secondary to community-acquired, methicillin-resistant Staphylococcus aureus in previously healthy children. A sign of the times? Ann Am Thorac Soc 2013;10(3):235-238. doi: 10.1513/AnnalsATS.201211-104BC.

13. Peter ID, Shehu AU, Ibrahim UA, et al. Pyopericardium with cardiac tamponade in a Nigerian child with acute osteomyelitis. J Cardiovasc Echogr 2017;27(2):71-73. doi: 10.4103/jcecho.jcecho_45_16.

14. Shih HI, Wu CJ, Chi CY, et al. Metastatic complications of pericarditis and cardiac tamponade as a result of Staphylococcus aureus bacteremia developing during antimicrobial therapy. Intern Med 2013;52(3):389-391.

15. Yoon JK, Rahimi MB, Fiore A, Schowengerdt K, Jureidini SB. Bacterial pancarditis with myocardial abscess: successful surgical intervention in a 14-month-old boy. Tex Heart Inst J 2015;42(1):55-57. doi: 10.14503/THIJ-13-3685.

16. Montera MW, Mesquita ET, Colafranceschi AS, Oliveira-Junior AM, Rabischoffsky A, Ianni BM, et al. Sociedade Brasileira de Cardiologia. I Diretriz Brasileira de Miocardites e Pericardites. Arq Bras Cardiol 2013;100(4 suppl. 1):1-36.

17. Barski L, Shalev L, Zektser M, Malada-Mazri H, Abramov D, Rafaely Y. Large hemorrhagic pericardial effusion. Isr Med Assoc J 2012;14(6):367-371.

18. Willner D, Bhimji S. Pericardial effusion. SourceStatPearls. Treasure Island (FL): StatPearls Publishing; 2017.

19. Hayase N, Inokuchi R, Nakamura K, et al. Sudden cardiac arrest caused by tuberculous pericarditis with hemorrhagic pericardial effusion. Intern Med 2012;51(22):3197-3201.