Purulent constrictive pericarditis caused by Salmonella enteritidis in a patient with adult-onset Still's disease: A case report. Issue 50 (December 2017)

• Record Type: Journal Article
• Authors: Kuo, Chia-Cheng; Yu, Wen-Liang; Lee, Chen-Hui; Wu, Nan-Chun
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 96:Issue 50(2017)
• Publication Date: 2017-12
• Subjects: adult-onset Still's disease -- constrictive pericarditis -- purulent pericarditis -- Salmonella enteritidis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000008949
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Purulent pericarditis is a rare and usually fatal disease. Immunodeficiency state and preexisting pericardial effusion can predispose patients to infections. However, we are not aware of similar cases in patients with adult-onset Still's disease (AOSD). In addition, it is seldom caused by Salmonella bacteria. Patient Concerns: We report a 30-year-old woman with dyspnea on exertion and epigastric fullness. She was newly diagnosed with AOSD 4 months previously and medicated with prednisolone. Diagnoses: Transthoracic echocardiography (TTE) and computed tomography revealed a thickened pericardium with loculations in the pericardial space, consistent with purulent constrictive pericarditis. Subsequent cultures of blood and pericardial fluid yielded S enteritidis . Interventions: She underwent subtotal pericardiectomy through a limited median sternotomy, and antibiotic therapy (ceftriaxone) for 1 month. Outcomes: The New York Heart Association functional classification downgraded from class III to class I. There was no recurrence during the 1-year follow-up. Lessons: This case presents an opportunity to highlight the importance of considering purulent pericarditis in patients previously diagnosed with AOSD. High clinical suspicion, early diagnosis, and prompt management can result in a better outcome in purulent pericarditis.