A 65-year-old man developed a fatal polymicrobial anaerobic pericardial effusion requiring drainage of 500 mL of fluid following a recent transbronchial needle aspiration.
Case Report (n=1)
This case highlights the rare but fatal complication of polymicrobial bacterial pericarditis following transbronchial needle aspiration, emphasizing the need for prompt recognition and aggressive management.
Abstract Introduction Bacterial pericarditis is extremely rare in developed countries. When it occurs, Staphylococcus and Streptococcus species are the most common pathogens. Polymicrobial anaerobic pericardial infections are exceedingly uncommon. We present a fatal case of polymicrobial pericardial effusion following a recent transbronchial needle aspiration (TBNA). Case Presentation A 65-year-old man with idiopathic pulmonary fibrosis, heart failure with mildly reduced ejection fraction, and alcohol use disorder presented with one week of weakness and fatigue and three days of bloody diarrhea. He was hemodynamically stable on arrival. Laboratory testing revealed leukocytosis (24.2 × 109/L) and elevated lactate (2.7 mmol/L). Chest radiograph showed a left lower lobe opacity and enlarged cardiac silhouette. Notably, he had undergone a TBNA lung biopsy of the left lower lobe three weeks prior.He was started on empiric antibiotics for community-acquired pneumonia and intravenous fluids. The patient developed hypotension, prompting echocardiography, which revealed a large circumferential pericardial effusion with fibrinous strands, consistent with tamponade physiology. Emergent pericardiocentesis drained 500 mL of turbid yellow fluid with subsequent hemodynamic improvement. The pericardial drain was removed after two days.Pericardial fluid cultures grew Streptococcus anginosus and multiple anaerobic bacteria. Concern for a gastrointestinal source led to a CT abdomen/pelvis, which showed enteritis without a definitive source. A repeat echocardiogram after drain removal demonstrated loculated reaccumulation of the effusion, necessitating a pericardial window. Cultures from this procedure grew S. anginosus, Bifidobacterium, Prevotella, and other anaerobic gram-negative rods and gram-positive cocci. He was treated with intravenous ampicillin-sulbactam, with plans to complete four weeks of antibiotics using oral amoxicillin-clavulanate. Unfortunately, he suffered a pulseless electrical activity arrest two days after discharge. Discussion Purulent bacterial pericarditis is rare, typically caused by Staphylococcus or Streptococcus species associated with pneumonia or empyema. Polymicrobial anaerobic infections may occur via contiguous spread, hematogenous seeding, or direct inoculation. In this case, hematogenous dissemination following recent TBNA was the most likely source.Prompt recognition, pericardial drainage, and targeted antimicrobial therapy are critical to prevent tamponade and sepsis. Recurrent or loculated infections may require surgical drainage. This case underscores the importance of vigilance for infectious complications following transbronchial procedures and highlights that early diagnosis and aggressive management remain key to improving outcomes in bacterial pericarditis. This abstract is funded by: NA
Akhtar et al. (Fri,) conducted a case report in Polymicrobial pericardial effusion (n=1). Pericardiocentesis and antibiotics was evaluated. A 65-year-old man developed a fatal polymicrobial anaerobic pericardial effusion requiring drainage of 500 mL of fluid following a recent transbronchial needle aspiration.
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