Rapidly Progressing Purulent Pericarditis Caused by Neisseria Meningitides Infection
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Journal of the American College of Cardiology
Purulent pericarditis is an uncommon manifestation of a Neisseria meningitides infection. Early differentiation of purulent pericarditis from viral pericarditis is critical due to life-threatening complications such as cardiac tamponade. We present a case of rapidly progressing purulent pericarditis associated with meningococcal bacteremia.
A 56-year-old male with HIV on HAART (CD4 count of 952 cells/mm 3 ) presents with fever and pleuritic chest pain. Electrocardiogram revealed diffuse ST elevations and transthoracic echocardiogram demonstrated a no pericardial effusion. A presumptive diagnosis of acute viral pericarditis was made and he was started on ibuprofen and colchicine. Within 12 hours, the patient developed hypotension. Bedside echocardiogram revealed a large circumferential pericardial effusion with right ventricular collapse consistent with cardiac tamponade. The patient underwent an emergent pericardiocentesis with drainage of 370 cc of purulent fluid. Pericardial fluid and blood cultures grew beta lactamase negative Neisseria meningitides group C. He was treated with IV ceftrixone and was discharged home with ibuprofen and colchicine.
Since antibiotics, purulent pericarditis accounts for less than 1% of all cases of pericarditis in developed countries. While Neisseria meningitides classically manifests as meningitis and bacteremia, it is important to be aware of its potential complication. Meningococcal pericarditis has been categorized as being a primary infection isolated to the pericardium, infection due to disseminated disease, or the result of a reactive immunologic response. Prognosis depends on prompt detection, antibiotic initiation, and drainage due to complications such as life-threatening cardiac tamponade or constrictive pericarditis. This is clearly demonstrated by the rapidly enlarging pericardial effusion with development of tamponade physiology in our patient.
This case illustrates an atypical presentation of meningococcal infection as purulent pericarditis and the need for early recognition due to its rapid progression.
Vira A, Hanson I. Rapidly progressing purulent pericarditis caused by Neisseria meningitides infection. J Am Coll Cardiol 2021;77(18 Suppl 1):1954.
70th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Virtual, May 15-17, 2021.