Purulent pericarditis due to Staphylococcus aureus in a patient with fever, cough and chest pain.

urulent pericarditis caused by Staphylococcus aureus is an infrequent complication of infections originating in another body location. It is typically an acute and often catastrophic illness. In this report a 23-year-old man presented to accident and emergency department with fever, productive cough and chest pain of 5 days duration, followed by shortness of breath. Chest x-ray showed air fluid level in the pericardium, chest CT scan showed evidence of large pericardial effusion, with bilateral pleural effusion (more in the right) Figure 1. Diagnosis was aided by echocardiography. The patient was admitted to the intensive care unit, and pericardiocentesis was performed, followed by the insertion of a single lumen catheter into the pericardial space. During the procedure, 900 ml of purulent pericardial fluid from the pericardial sac was drained. Antibiotic therapy was started upon admission to the hospital. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. Intravenous vancomycin was given. A total of 2600 ml of frank pus was drained from the pericardium through the single lumen catheter during the following days. But, the patient remained febrile, repeated echocardiography examinations showed signs of constrictive pericarditis, consequently, partial pericardiectomy was performed, while intravenous vancomycin continued. On the consequent, days the patient's general condition improved, and the fever subsided. Two weeks postpericardiotomy the patient remained asymptomatic and consequently, he was discharged. Acute pericarditis is a syndrome caused by inflammation of the pericardium (the sac that encloses the heart and great vessels). The pericardium is composed of 2 layers: a fibrous outer layer called the parietal pericardium, and a serous inner layer called the visceral pericardium. The 2 layers are attached by connective tissue and separated by up to 50 mL of pericardial fluid.1 The pericardium function, as a barrier against infection and the spread of malignancy, limits excessive cardiac movement, and reduces friction between the heart and other organs.1,2 The intrapericardial pressure, which is normally negative, also has an important role in allowing distention of the cardiac chambers in diastole.2 In acute pericarditis, an inflammatory response to some agent or event P Clinical Note