PDF(Pubmed)
Abstract：
Purulent pericarditis is a rare and potentially life-threatening condition characterized by infection of the pericardial space. We describe a case of purulent bacterial pericarditis in a 41-year-old male with no significant medical or surgical history who had concomitant pulmonary Histoplasma infection. Streptococcus intermedius was the bacteria directly responsible for the pericardial infection, though co-infection with histoplasmosis likely predisposed him to develop purulent pericarditis. We hypothesize histoplasmosis caused mediastinal lymphadenopathy, facilitating contact between a necrotic lymph node and the pericardium and contiguous suppuration of bacteria to the pericardial space. We treated S. intermedius and Histoplasma capsulatum with ceftriaxone and amphotericin B, respectively. Additionally, the patient presented in cardiac tamponade requiring emergent pericardiocentesis and drain placement. His course was also complicated by pericardial constriction. Cardiac magnetic resonance confirmed this, showing inflamed pericardium and abnormal septal motion with inspiration, and he had symptoms refractory to antimicrobials and anti-inflammatories. As such, he required pericardiectomy. This case demonstrates maintaining suspicion for secondary infectious foci as a contributor to the pathogenesis of purulent pericarditis is important, as pulmonary histoplasmosis played a pivotal role in allowing S. intermedius to spread to the pericardium but was not the primary infection. It also highlights the multifaceted evaluation and management of purulent pericarditis, highlighting the role of echocardiography and emergent pericardial drainage if cardiac tamponade is present, the importance of targeted antimicrobial therapy, the superior ability of cardiac magnetic resonance to identify pericardial constriction as a sequela of purulent pericarditis, and indications for pericardiectomy.
摘要：
化脓性心包炎是一种罕见且可能危及生命的疾病，其特征是心包间隙感染。我们描述了一名41岁男性的化脓性细菌性心包炎病例，该男性没有明显的医疗或手术史，并伴有肺组织胞浆感染。中间链球菌是直接导致心包感染的细菌，尽管与组织胞浆菌病合并感染可能易患化脓性心包炎。我们假设组织胞浆菌病引起纵隔淋巴结病，促进坏死淋巴结和心包之间的接触和细菌对心包间隙的连续化脓。我们用头孢曲松和两性霉素B治疗中间链球菌和组织胞浆，分别。此外,患者出现心脏压塞，需要紧急心包穿刺术和引流。他的病程也因心包收缩而变得复杂。心脏磁共振证实了这一点，表现出发炎的心包和异常的间隔运动，他有抗菌药物和抗炎药难以治疗的症状。因此，他需要进行心包切除术.此病例表明，怀疑继发感染灶是化脓性心包炎发病机理的重要因素，因为肺组织胞浆菌病在允许S.intermedius扩散到心包中起关键作用,但不是原发感染.它还强调了化脓性心包炎的多方面评估和管理，强调如果存在心脏压塞，超声心动图和紧急心包引流的作用，靶向抗菌治疗的重要性，心脏磁共振识别心包收缩作为化脓性心包炎后遗症的优越能力，以及心包切除术的适应症.
