Purulent pericarditis, multi-site abscesses and ketoacidosis in a patient with newly diagnosed diabetes: a rare case report.
BACKGROUND
Purulent pericarditis is an acute and fulminant disease characterized by pus accumulation in the pericardial space. Its incidence has declined substantially and the common pathogen has changed since the beginning of the antibiotic era; however, it is still found in some patients with immunocompromised conditions.


METHODS
We report a rare case in which the onset of diabetes mellitus presented as extremely high HbA1c concentration, ketoacidosis, multi-site abscesses and purulent pericarditis. After antibiotic therapy and pericardiocentesis, the purulent pericarditis still did not resolve and further intrapericardial thrombolytic therapy also failed. Finally, this patient was treated successfully by surgical debridement and pericardiectomy.


CONCLUSIONS
In the immunocompromised state of severe hyperglycaemia, purulent pericarditis is a possible complication of uncontrolled infection. If purulent pericarditis cannot be cured using non-surgical treatments, such as antibiotic therapy, pericardiocentesis and intrapericardial thrombolytic therapy, a surgical pericardiectomy should be considered to avoid morbidity and mortality.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital.
H-H
HH
Lee
C-Y
CY
Chu
H-M
HM
Su
T-H
TH
Lin
W-C
WC
Voon
W-T
WT
Lai
S-H
SH
Sheu
P-C
PC
Hsu
D000038:Abscess / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007662:Ketosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D020519:Pericardiocentesis; D010493:Pericarditis / Q000175:diagnosis* / Q000628:therapy*; D013492:Suppuration; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents