Key result
Targeted antibiotics after pericardial drainage resolve nocardial effusion and tamponade in a case report.
Case Report (n=1)
No
Nocardia should be considered as a rare cause of exudative pericardial effusion and cardiac tamponade even in immunocompetent patients, highlighting the need for microbiological confirmation rather than empiric tuberculosis treatment in endemic areas.
Nocardia should be considered in immunocompetent cardiac tamponade; hypothesis-generating for microbiologic confirmation over empiric TB therapy in endemic areas.
We report the case of a woman in her 40s with type II diabetes mellitus and a known ostium secundum atrial septal defect (23 mm, left-to-right shunt) diagnosed one year back. The patient presented with progressive dyspnea on exertion for the last three months, along with low-grade fever and fatigue. Clinical and echocardiographic evaluation revealed massive pericardial effusion with features of cardiac tamponade. Pericardial drainage via a pigtail catheter yielded 650 mL of exudative fluid. Pericardial effusion was negative for fungal culture, malignant cytology, and tubercular workup. Adenosine deaminase was negative, and the effusion was predominantly neutrophilic and exudative in nature. The bacterial culture showed the presence of Nocardia. The patient was started on trimethoprim-sulfamethoxazole, following which there was significant improvement in clinical status over the next month, and the pericardial effusion resolved. This case highlights the importance of early microbiological diagnosis and targeted antimicrobial therapy in patients with pericardial effusion to optimize clinical outcomes, particularly in tuberculosis-endemic countries, where exudative pericardial effusion is often presumed to be of tubercular origin.
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Jain et al. (2026) conducted a case report in Immunocompetent middle-aged woman with type II diabetes mellitus and congenital heart disease (ostium secundum atrial septal defect 23 mm) presenting with massive pericardial effusion and cardiac tamponade (n=1). Trimethoprim-sulfamethoxazole and linezolid initially, then linezolid and amoxicillin-clavulanate was evaluated on Resolution of pericardial effusion and clinical improvement in symptoms of cardiac tamponade. Treatment with targeted antibiotics (linezolid and amoxicillin-clavulanate) after pericardial drainage led to complete resolution of nocardial pericardial effusion and clinical recovery in an immunocompetent middle-aged woman with congenital heart disease and cardiac tamponade.
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