title: Pericarditis as a presenting sign of infective endocarditis: two case reports and review of the literature.
abstract: Pericarditis as a presenting sign of infective endocarditis is rare. Here we describe 2 cases and an additional 19 cases of pericarditis as a presenting sign of infective endocarditis reported during the last 40 y. 71% of patients were young males (mean age 43.2 y). The most commonly reported underlying conditions were diabetes mellitus type 2 (5 patients, 24%), and substance or alcohol abuse (4 patients, 19%). The native aortic valve was the most frequently involved valve. The most common symptoms were fever, cough or dyspnoea, and chest pain. Overt tamponade was diagnosed in 47% of the patients. However, pulsus paradoxus and pericardial friction rub were rare. A heart murmur was heard in 12 patients (57%). Staphylococcus aureus was the most commonly isolated pathogen concomitantly from blood and pericardial fluid. 16 patients (76%) were operated. Six underwent a pericardial procedure, 5 underwent valve replacement, 4 both, and 1 patient was operated for pseudoaneurysm. Mortality rates were 60% and 31% of patients treated with antibiotics alone versus antibiotics and surgical intervention, respectively. In patients presenting with pericarditis with or without cardiac tamponade, the possibility of infective endocarditis should be considered. Optimal therapy should consist of antibiotics and surgical intervention.
authors.affiliation: Infectious Diseases Unit, Department of Internal Medicine D, Rabin Medical Centre, Beilinson Hospital, Petah Tiqwa, Israel.
authors.forename: Lior H
authors.initials: LH
authors.lastname: Katz
authors.forename: Silvio
authors.initials: S
authors.lastname: Pitlik
authors.forename: Eyal
authors.initials: E
authors.lastname: Porat
authors.forename: Phillippe
authors.initials: P
authors.lastname: Biderman
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002305:Cardiac Tamponade; D003023:Cloxacillin / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005334:Fever; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010493:Pericarditis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D003023:Cloxacillin