Key result
MSSA endocarditis progresses to fatal purulent pancarditis despite targeted antibiotic therapy.
Why the study?
Infective endocarditis is a rare and deadly condition, and bacterial pancarditis is an exceedingly rare and severe complication.
Case Report (n=1)
Pericardial effusion complicating infective endocarditis should raise suspicion for purulent pericarditis and bacterial pancarditis, warranting prompt investigation and surgical drainage or diagnostic puncture.
May indicate rapid pancarditis risk in MSSA IE; hypothesis-generating and should not yet alter practice.
BACKGROUND: Infective endocarditis (IE) is rare and deadly. We report the case of IE rapidly progressing to pancarditis. CASE SUMMARY: A man in his 60s with no medical history presented with fever, chest pain, and embolic phenomena. Initial evaluation suggested myocardial infarction, but angiography was normal. Echocardiography revealed an aortic valve vegetation. Blood cultures grew methicillin-sensitive Staphylococcus aureus. Despite appropriate antibiotics, he developed rapidly progressive purulent pericardial effusion and died. Pericardial fluid cultures confirmed S aureus purulent pericarditis, establishing the diagnosis of pancarditis involving endocardium, myocardium, and pericardium. DISCUSSION: Bacterial pancarditis is an exceedingly rare and severe complication of IE. Pericardial effusion associated with IE should raise suspicion for purulent pericarditis and prompt rapid referral for surgical drainage or diagnostic puncture. TAKE-HOME MESSAGES: Consider bacterial pancarditis when IE is complicated by myocardial and pericardial involvement. Pericardial effusion in IE requires prompt investigation and drainage or at least a diagnostic puncture.
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Koenig et al. (2026) conducted a case report in Fulminant methicillin-sensitive Staphylococcus aureus infective endocarditis rapidly progressing to pancarditis (n=1). Appropriate antibiotics was evaluated on Survival / clinical progression. Methicillin-sensitive S. aureus infective endocarditis progressed to fatal purulent pericarditis and pancarditis in 1 immunocompetent man in his 60s despite appropriate antibiotics.
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