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Purulent pericarditis, cardiac tamponade and hypothyroidism

Abstract:

BACKGROUND: Purulent pericarditis is a localized infection of the pericardial space, with the production of a macro or microscopically purulent exudate, it usually manifests as a serious disease, and must be managed aggressively and comprehensively, otherwise death is inevitable. CLINICAL CASE: A 27-year-old male patient with a history of hypothyroidism who attended to the emergency department for presenting cough with greenish expectoration, pain on the side of the left hemithorax, fever with chills. He was hospitalized with the diagnosis of a community pneumonia, not having satisfactory evolution to the therapy prescribed with amoxicillin plus clavulanic acid, deteriorating his general condition, with signs of hemodynamic instability, tachycardia, arterial hypotension, jugular engorgement, meriting admission to care intensive to support vital functions. The presence of severe pericardial effusion was verified by echocardiography and tomography, performing pericardiocentesis where 450 mL of purulent fluid were extracted; in both the blood cultures and the pericardial fluid cultures Streptococcus pneumoniae was isolated. CONCLUSIONS: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of the utmost importance to avoid serious hemodynamic compromise. Among the most serious complications is cardiac tamponade with its consequences. Antibiotic therapy combined with pericardiocentesis dramatically reduces the mortality associated with purulent pericarditis.