Pericardial Abscess: A Rare Complication of Pyogenic Liver Abscess

Massive pericardial effusion from rupture of a hepatic abscess is rare. We report an unusual case of a pericardial abscess caused by a poorly treated hepatic abscess. This is the case of a 60-year old male with exertional dyspnea, intermittent low back pain, occasional low-grade fever; and progressive malaise, anorexia and weight loss. One month prior to admission, an abdominal ultrasound showed a left hepatic abscess. The patient was treated with metronidazole, but had poor compliance. A later two dimensional echocardiogram with doppler showed a massive pericardial effusion with no signs of tamponade. The patient was then referred to the Philippine Heart Center. On physical examination, heart sounds were muffled. Hematology revealed leukocytosis. Electrocardiography showed sinus tachycardia, isolated premature ventricular depolarization, and low-voltage chest leads. Subxiphoid tube pericardiostomy drained one liter of purulent non-foul smelling pericardial fluid. Cytology and chemistry showed an inflammatory process. Gram staining showed pus cells and gram-positive cocci in pairs. The patient was given intravenous (IV) metronidazole 500 mg every 8 hours, and IV ampicillin 1.5 mg every 8 hours. Computerized tomography of the upper abdomen revealed a large abscess at the lateral segment of the left lobe of the liver; hepatic cortical cysts; and minimal pericardial effusion. On the 20th hospital day, the subxiphoid catheter was removed and the patient was discharged. Home medications included oral metronidazole and ampicillin-sulbactam for 2 weeks. The hepatic catheter was then subsequently removed after another 2 weeks.