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Pericardial empyema, a rare but often fatal condition, is frequently diagnosed postmortem. Staphylococcus aureus is the most common causative organism. This case involves a 73-year-old male with diabetes and hypothyroidism who presented with chills, fever, and a persistent skin infection. Cultures revealed Methicillin-resistant Staphylococcus aureus (MRSA), and he was treated with intravenous Vancomycin. On the third day, the patient experienced sudden chest pain, and examination revealed muffled heart sounds, jugular venous distension, sinus tachycardia, and diffuse ST elevation. Transthoracic echocardiography (TTE) showed a large pericardial effusion. An emergent pericardiocentesis was performed, followed by a pericardial window, but the patient later developed a clot, leading to the removal of 1000 ml of the bloody fluid. He subsequently became dyspneic and experienced pulseless electrical activity, resulting in death from cardiopulmonary collapse. MRSA was confirmed in the pericardial fluid. This case underscores the critical need for prompt diagnosis and treatment of pericardial empyema due to its high mortality risk and often ambiguous clinical presentation.
Hazique et al. (Wed,) studied this question.