Fatal acute purulent pericarditis in a patient with renal transplant: a case report.
OBJECTIVE
Acute purulent pericarditis is a lifethreatening disease, although it is becoming uncommon in the era of antibiotics.


METHODS
We present a case of fatal acute massive purulent pericarditis in a kidney transplant recipient.


RESULTS
A 46-year-old woman had an unrelated commercial renal transplant in 2003. She had a history of diabetes mellitus and hepatitis C infection. Kaposi sarcoma developed in the posttransplant period. Her last admission was prompted by the development of acute rejection confirmed by transplant biopsy, and she was treated with intravenous methylprednisolone. Three days before her death, thrombophlebitis of the right forearm was noted. We postulate that this could have been the source of the fulminant purulent pericarditis, as the organism in the pericardial fluid was Staphylococcus aureus, a common pathogen in thrombophlebitis. She was initially resuscitated after cardiac arrest but died shortly after.


CONCLUSIONS
Severe purulent pericarditis in the immunocompromised patient can occur abruptly. The source of infection may show minimal signs and symptoms. Thrombophlebitis and other apparently minor infections should not be overlooked in such patients.
Department of Nephrology, Royal Hospital, Muscat. nabmoh@omantel.net.om
Nabil
N
Mohsin
Mohammad
M
Budruddin
Jha
J
Amitabh
Mohammad
M
Ehab
Pakkayara
P
Abbas
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000628:therapy; D006323:Heart Arrest / Q000382:microbiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D010492:Pericardiectomy; D010493:Pericarditis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D011859:Radiography; D006435:Renal Dialysis; D012151:Resuscitation; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013924:Thrombophlebitis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D008775:Methylprednisolone