Staphylococcal pericarditis in a chronic renal failure patient.
A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.
Singh
N P
NP
Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. nanu_singh@yahoo.com
Prakash
Anupam
A
Makhija
Aman
A
Garg
Dheeraj
D
Pathania
Anjali
A
Agarwal
S K
SK
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D008795:Metronidazole / Q000627:therapeutic use; D010493:Pericarditis / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D013211:Staphylococcus aureus; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D014640:Vancomycin; D002443:Ceftriaxone