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Purulent pericarditis secondary to septic arthritis: a rare life threatening association
  1. V Karuppaswamy,
  2. A Shauq,
  3. N Alphonso
  1. Department of Paediatric Cardiology and Cardiac Surgery, Royal Liverpool Children’s NHS Trust, Alder Hey Hospital, Eaton Road, Liverpool L12 2AP, UK
  1. vkswami{at}

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A 23-day-old baby was admitted with a diagnosis of septic arthritis of his right shoulder (positive joint aspirate of Streptococcus pneumonia). After 2 days of antibiotic treatment he was noted to be oedematous, tachypnoeic and tachycardic and a cardiac opinion was sought. Echocardiogram (fig 1) suggested a dense collection surrounding the heart suggestive of fibrinous effusion or a mass. Computerised tomography (CT) instead of magnetic resonance imaging (MRI) was performed because of poor clinical condition, which showed a thick rim of tissue in the pericardial space compressing the ventricles (fig 2). The child became acutely unstable and an emergency pericardiotomy via a median sternotomy was performed. The heart was encased by a smooth yellowish white material, which proved to be a thick walled fibrous sac of slough and pus (fig 3). The sac was sub-totally excised with dramatic improvement in haemodynamics. Although mediastinal culture was negative, blood cultures grew Staphylococcus aureus. The patient received a 6-week course of intravenous antibiotics and made a slow recovery from subsequent multi-organ failure.


Purulent pericarditis is an uncommon illness.1 It typically affects children less than 4 years of age and is usually secondary in nature.2 Causative organisms include haemophilus type B, S aureus, pneumococcus and meningococcus. S aureus is the most common organism and septic arthritis is the most common concomitant illness.3 It is a medical and surgical emergency and surgical drainage appears to be preferred since fibrinous deposits may be removed more effectively.4 Development of constrictive pericarditis is a possible long-term complication.

The diagnosis of purulent pericarditis is difficult to make, as in our patient, and requires a high index of suspicion. Clinical signs and symptoms are often masked by the coexistent illness. Echocardiography and CT imaging can be deceptive and the patient should be closely monitored for sub-clinical signs of tamponade.

Parental/guardian informed consent was obtained for publication of figures 1, 2 and 3.


This article has been adapted from Karuppaswamy V, Shauq A, Alphonso N. Purulent pericarditis secondary to septic arthritis: a rare life threatening association Archives of Disease in Childhood 2008;93:277



  • Competing interests: None.