Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report
Abstract Background After the introduction of antibiotics, pneumococcal pericarditis has become a rare finding. However, this severe condition with high mortality and complication rates requires rapid recognition and intervention. Herein, we describe a patient that presents with this rare disease re...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03548-8 |
| _version_ | 1828166979681255424 |
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| author | Suzan Dijkstra Jaco H. Houtgraaf Sanjay U. C. Sankatsing |
| author_facet | Suzan Dijkstra Jaco H. Houtgraaf Sanjay U. C. Sankatsing |
| author_sort | Suzan Dijkstra |
| collection | DOAJ |
| description | Abstract Background After the introduction of antibiotics, pneumococcal pericarditis has become a rare finding. However, this severe condition with high mortality and complication rates requires rapid recognition and intervention. Herein, we describe a patient that presents with this rare disease resulting in an unusual, fatal outcome. Case presentation A previously healthy, 68-year-old, Caucasian male presented with progressive fatigue, dyspnea, and appetite loss since 12 days. He was diagnosed with diabetes mellitus 5 days before presentation but had not started treatment. After echocardiography revealed pericardial effusion, pericardiocentesis was performed with immediate drainage of a large volume of purulent fluid suggestive of bacterial pericarditis. On the basis of cultures showing Streptococcus pneumoniae as the causative organism, a regimen of intravenous penicillin was initiated. Additionally, antidiabetic drugs were started as his diabetes also predisposed him to invasive infectious disease. No other primary source of the infection, such as pneumonia, was found. Though the patient was found to be severely ill on admission, his clinical condition improved. A total of 1235 mL of pericardial fluid was drained, and adequate drainage was confirmed by daily, bedside echocardiography. However, 6 days post-admission, the patient suddenly developed intrapericardial bleeding with blood clot formation on the right chamber with subsequent cardiac tamponade. With the blood clot precluding adequate drainage through the catheter, the patient suffered cardiac arrest and died before surgical intervention could be attempted. Conclusions Pneumococcal pericarditis is a very rare but life-threatening disease that necessitates immediate intervention with antibiotics and drainage of the pericardial effusion. Thus, although symptoms may be variable and aspecific, early recognition of this condition is critical. The present case illustrates the presentation, diagnosis, and clinical course of a patient presenting with pneumococcal pericarditis in current clinical practice. Through this report, we aimed to increase awareness among clinicians both of the existence of this phenomenon and of its uncertain clinical course. As is highlighted by the case, patients with pneumococcal pericarditis are at high risk for complications and should be closely monitored. |
| first_indexed | 2024-04-12T02:10:29Z |
| format | Article |
| id | doaj.art-b2397030931c413aa3f13d37a73ea1de |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-12T02:10:29Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-b2397030931c413aa3f13d37a73ea1de2022-12-22T03:52:24ZengBMCJournal of Medical Case Reports1752-19472022-09-011611510.1186/s13256-022-03548-8Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case reportSuzan Dijkstra0Jaco H. Houtgraaf1Sanjay U. C. Sankatsing2Department of Internal Medicine, DiakonessenhuisDepartment of Cardiology, DiakonessenhuisDepartment of Internal Medicine, DiakonessenhuisAbstract Background After the introduction of antibiotics, pneumococcal pericarditis has become a rare finding. However, this severe condition with high mortality and complication rates requires rapid recognition and intervention. Herein, we describe a patient that presents with this rare disease resulting in an unusual, fatal outcome. Case presentation A previously healthy, 68-year-old, Caucasian male presented with progressive fatigue, dyspnea, and appetite loss since 12 days. He was diagnosed with diabetes mellitus 5 days before presentation but had not started treatment. After echocardiography revealed pericardial effusion, pericardiocentesis was performed with immediate drainage of a large volume of purulent fluid suggestive of bacterial pericarditis. On the basis of cultures showing Streptococcus pneumoniae as the causative organism, a regimen of intravenous penicillin was initiated. Additionally, antidiabetic drugs were started as his diabetes also predisposed him to invasive infectious disease. No other primary source of the infection, such as pneumonia, was found. Though the patient was found to be severely ill on admission, his clinical condition improved. A total of 1235 mL of pericardial fluid was drained, and adequate drainage was confirmed by daily, bedside echocardiography. However, 6 days post-admission, the patient suddenly developed intrapericardial bleeding with blood clot formation on the right chamber with subsequent cardiac tamponade. With the blood clot precluding adequate drainage through the catheter, the patient suffered cardiac arrest and died before surgical intervention could be attempted. Conclusions Pneumococcal pericarditis is a very rare but life-threatening disease that necessitates immediate intervention with antibiotics and drainage of the pericardial effusion. Thus, although symptoms may be variable and aspecific, early recognition of this condition is critical. The present case illustrates the presentation, diagnosis, and clinical course of a patient presenting with pneumococcal pericarditis in current clinical practice. Through this report, we aimed to increase awareness among clinicians both of the existence of this phenomenon and of its uncertain clinical course. As is highlighted by the case, patients with pneumococcal pericarditis are at high risk for complications and should be closely monitored.https://doi.org/10.1186/s13256-022-03548-8Bacterial pericarditisStreptococcus pneumoniaeCardiac tamponadeDiabetes mellitusAcute illnessCase report |
| spellingShingle | Suzan Dijkstra Jaco H. Houtgraaf Sanjay U. C. Sankatsing Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report Journal of Medical Case Reports Bacterial pericarditis Streptococcus pneumoniae Cardiac tamponade Diabetes mellitus Acute illness Case report |
| title | Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report |
| title_full | Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report |
| title_fullStr | Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report |
| title_full_unstemmed | Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report |
| title_short | Pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus: a case report |
| title_sort | pneumococcal pericarditis in a patient with newly diagnosed diabetes mellitus a case report |
| topic | Bacterial pericarditis Streptococcus pneumoniae Cardiac tamponade Diabetes mellitus Acute illness Case report |
| url | https://doi.org/10.1186/s13256-022-03548-8 |
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