Purulent pericarditis as a complication of bacteraemic Enterococcus faecalis urinary tract infection

BMJ Case Rep. 2017 Mar 15:2017:bcr2017219498. doi: 10.1136/bcr-2017-219498.

Abstract

Purulent pericarditis is a rare clinical entity in the modern antibiotic era. The most common portal of entry is thought to be direct extension from a primary lung source and is usually caused by Staphylococcus aureus, Streptococcus pneumoniae or Haemophilus influenzae We report the case of a man aged 69 years who presented with purulent pericarditis due to Enterococcus faecalis likely caused by haematogenous spread from a urinary tract source. Urgent pericardiocentesis was vital and restored his haemodynamic stability. He was treated for a total duration of 4 weeks with susceptible antibiotics. Echocardiography 3 weeks later showed persistent resolution of the pericardial effusion. This case shows that prompt diagnosis and drainage of the pericardial effusion are vital to achieve a positive outcome in purulent pericarditis. To the best of our knowledge, this is the first reported case of purulent pericarditis caused by E. faecalis from a urinary tract source.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Enterococcus faecalis / isolation & purification*
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / drug therapy
  • Humans
  • Male
  • Pericardiocentesis
  • Pericarditis / etiology*
  • Pericarditis / therapy
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology

Substances

  • Anti-Bacterial Agents