title: Enterobacter cloacae pericardial effusion in a frail elderly patient.
abstract: We report a case of a frail 82-year-old man with seronegative rheumatoid arthritis and a recent pacemaker insertion, admitted with pulmonary oedema and a symptomatic pericardial effusion. He was treated with diuretics and an urgent pericardiocentesis, a sample from which cultured Enterobacter cloacae. A subsequent abdominal CT scan revealed faecal loading, an abnormal anorectal canal and sigmoid colon and a bowel perforation. Endoscopy, biopsies and histopathology confirmed a diagnosis of cytomegalovirus (CMV) colitis with coexistent fungal infection. The E. cloacae infection was successfully treated with 6 weeks of intravenous meropenem, while the CMV and fungal infections were treated with a combination of valganciclovir and fluconazole. We postulate that the bowel perforation resulted from a combination of CMV colitis, faecal loading and steroid therapy and led to bacterial translocation of E. cloacae and the development of the pericardial effusion. This case represents an unusual pathophysiology for the development of an E. cloacae pericardial effusion.
authors.affiliation: Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: H J
authors.initials: HJ
authors.lastname: Blundell
authors.affiliation: Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Mason
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications; D003092:Colitis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D012809:Colon, Sigmoid / Q000002:abnormalities / Q000000981:diagnostic imaging; D003586:Cytomegalovirus Infections / Q000150:complications; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016972:Enterobacter cloacae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000150:complications*; D016330:Frail Elderly; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis*; D008297:Male; D000077731:Meropenem; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D020519:Pericardiocentesis / Q000379:methods; D011654:Pulmonary Edema / Q000150:complications; D011859:Radiography; D012007:Rectum / Q000002:abnormalities / Q000000981:diagnostic imaging; D012307:Risk Factors; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004232:Diuretics; D013845:Thienamycins; D000077731:Meropenem