A Case of Purulent Pericarditis Due to Actinomyces From an Odontogenic Focus
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Pericarditis is inflammation of pericardium, with causes including infectious, autoimmune, trauma, iatrogenic, or idiopathic. Purulent pericarditis is a rare, localized infection of the pericardial sac, in which bacterial or fungal infections produce pus in the pericardium. Commonly isolated organisms include staphylococcus or streptococcus species. Actinomyces is a group of anaerobic grampositive bacteria, which most commonly inhabits the oral cavity. Actinomyces leading to infection of the thorax is uncommon and rarely reported, and most commonly is secondary to contiguous spread from a pulmonary focus. We present a rare case of purulent pericarditis due to actinomyces from an odontogenic focus. A 39-year-old male with a history of frequent dental infections presented to the emergency room with sharp, stabbing chest pain that radiated to the back and dyspnea. Two weeks prior, he was diagnosed with a dental infection and completed a course of amoxicillinclavulanate. He admitted to poor oral hygiene with no dental follow up. On arrival, vitals were stable. Labs were remarkable for an elevated white blood cell count (43.3 x 10*9/L), procalcitonin of 3.72 ng/mL, and elevated CRP (266.3 mg/L). Initial chest x-ray revealed a 2.2 cm right lower lobe nodule and a 0.9 cm nodular opacity in the right lung base. A CTA of the thorax, abdomen, and pelvis was notable for a pericardial fluid collection with pericardial thickening and enhancement, and bulky mediastinal masses, findings initially concerning for mediastinitis. The patient became hemodynamically unstable after admission and emergent pericardiocentesis was performed due to concern of tamponade physiology seen on bedside ultrasound. 350cc of yellow cloudy/milky fluid was removed and a pericardial drain was placed. The patient’s pericardial fluid cultures were positive for rare streptococcus constellatus and rare actinomyces odontolyticus. A CT of the mandible was obtained, showing numerous damaged teeth, majority with periapical lucencies, concerning for an odontogenic infection. The patient's purulent pericarditis was treated with ampicillin-sulbactam 3g and he was transitioned to ertapenem 1g daily on discharge. Purulent pericarditis most commonly arises from infections caused by Staphylococcus or Streptococcus species. The involvement of Actinomyces as a cause of purulent pericarditis is atypical and is typically seen when there is an associated pulmonary focus. This case highlights the potential for actinomyces odontogenic infections to cross fascial planes and result in unexpected purulent infections in the thoracic region. It also underscores the importance of promptly treating oral infections and emphasizes the need to expand antibiotic coverage to include anaerobic organisms.
Volume
211
First Page
A3734
Last Page
A3734
Recommended Citation
Al-Nabolsi A, Hubbard C, Marchewka TC, Shatila M. A case of purulent pericarditis due to Actinomyces from an odontogenic focus. Am J Respir Crit Care Med. 2025 May;211:A3734. doi:10.1164/ajrccm.2025.211.Abstracts.A3734
DOI
10.1164/ajrccm.2025.211.Abstracts.A3734
Comments
American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA