title: Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report.
abstract: BACKGROUND
  Non-typhoidal Salmonella (NTS) is mostly restricted to gastroenteritis; however, we report a case of Salmonella pericarditis complicated by tamponade and spontaneous ventricular wall rupture.
  
  
  METHODS
  A 67-year-old male presents to the Emergency Department with complaints of fevers, chills and body aches. A chest radiograph displayed an infiltrate and an electrocardiogram suggested acute pericarditis. An echocardiogram revealed a small pericardial effusion without tamponade. Broad-spectrum antibiotics were initiated until Salmonella was discovered in blood cultures. The hospital course was complicated by sudden decompensation, and a repeat echocardiogram displayed a large effusion with constrictive physiology. During a pericardial window, the tissue was noted to have a thickened appearance with a complex effusion. The following day, the patient developed increased chest tube drainage, hypotension and acidosis, requiring an emergent sternotomy. The right ventricle was friable and had spontaneously ruptured. After ventricular repair and pericardiectomy, the tissue was sent for cultures and pathology. The specimen revealed Salmonella enteriditis. Treatment with ceftriaxone and ciprofloxacin was initiated. On postoperative day four, the patient was successfully extubated. Repeat blood cultures were negative.
  
  
  CONCLUSIONS
  In our review of literature, only 19 cases of NTS pericarditis have been reported. Prior to our case, salmonellosis resulting in ventricular rupture has been reported once. Early diagnosis and treatment is crucial in minimizing morbidity and mortality. Clinical suspicion based on electrocardiogram and hemodynamic assessment is critical in suspecting pericardial effusion in a patient with nonspecific symptoms and Salmonella bacteremia. The key to recovery involves aggressive treatment, including pericardiectomy and antibiotic treatment.
authors.affiliation: Department of Internal Medicine, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Chand
authors.affiliation: Department of Internal Medicine, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
authors.forename: Ruby
authors.initials: R
authors.lastname: Jhaj
authors.affiliation: Department of Cardiology, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sanam
authors.affiliation: Department of Pulmonology and Critical Care, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, St. John Providence Hospital and Medical Center, 16001 W Nile Mile Road, Southfield, MI 48075, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Alexander
keywords: Pericarditis; Salmonella pericarditis; Tamponade; Ventricle rupture; salmonella enteriditis