Emergent pericardiocentesis (300cc drained) and medical therapy successfully treated life-threatening Streptococcus pneumoniae purulent pericarditis with cardiac tamponade in a 39-year-old HIV patient.
Case Report (n=1)
Purulent pericarditis due to Streptococcus pneumoniae is a rare but highly fatal complication in HIV patients that requires high clinical suspicion and prompt pericardiocentesis to prevent cardiac tamponade.
Abstract Introduction Purulent pericarditis is a rare but life-threatening complication of Streptococcus pneumoniae, now uncommon in the post-vaccine era and most frequently seen in immunocompromised patients. Without early recognition and drainage, it can rapidly progress to cardiac tamponade and death. Case A 39-year-old male patient with HIV/AIDS (CD4 179), non-compliant with ART, polysubstance use, presented with two weeks of subjective fever, persistent malaise, shortness of breath and pleuritic chest pain, accompanied with upper respiratory symptoms. Prior to this admission the patient was in the Emergency Department complaining of malaise and body aches which were attributed to methamphetamine use. On initial examination, patient was found to be hypotensive (90/60mmHg), tachycardic (140bpm), hypoxic SpO2 90% on room air and afebrile. Bedside ultrasound showed moderate pericardial effusion, plethoric IVC and right ventricle dysfunction, concerning for tamponade. EKG showed diffuse ST elevation and peaked T waves with two negative values of high sensitivity troponins, consistent with pericarditis. Respiratory panel was positive for enterovirus. The patient underwent an emergent pericardiocentesis where 300cc of seropurulent fluid was removed. Fluid analysis showed WBC 5364 cells/uL, LDH 10823U/L, Glucose 14 mg/dl. Blood cultures and pericardial fluid were positive for Streptococcus pneumoniae confirming diagnosis of purulent pericarditis. The patient was treated with ceftriaxone, colchicine and aspirin leading to significant improvement and resolving symptoms. Discussion Despite its rarity in the antibiotic era, bacterial pericarditis due to Streptococcus pneumoniae remains highly fatal, especially among HIV-infected patients. This case highlights the critical need for heightened clinical suspicion and prompt diagnostic imaging when immunocompromised patients present with nonspecific symptoms. Initial attribution of symptoms to substance use delayed diagnosis, underscoring the risk of anchoring bias. Early recognition and swift intervention are essential to prevent rapid progression to tamponade and death. Clinicians must be mindful of atypical presentations in high-risk populations to optimize outcomes. This abstract is funded by: None
Cobaj et al. (Fri,) conducted a case report in Purulent pericarditis with cardiac tamponade (n=1). Emergent pericardiocentesis, ceftriaxone, colchicine, and aspirin was evaluated. Emergent pericardiocentesis (300cc drained) and medical therapy successfully treated life-threatening Streptococcus pneumoniae purulent pericarditis with cardiac tamponade in a 39-year-old HIV patient.