title: Patient with Small Cell Lung Carcinoma and Suspected Right Upper Lobe Abscess Presenting with a Purulent Pericardial Effusion.
abstract: BACKGROUND Cardiac tamponade caused by pericardial effusion has a high mortality rate; thus, it is important to diagnose and treat this condition immediately. Specifically, bacterial pericarditis, although now very rare, is often fatal because of its fulminant process. CASE REPORT We present a case of a 61-year-old man with metastatic small cell lung cancer undergoing chemotherapy who presented with fatigue, poor appetite, and altered mental status. He was found to have a large-volume pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis. The pericardial effusion was nonmalignant, with cultures growing Streptococcus pneumoniae. It was only after his emergent pericardiocentesis that previous imaging from one month prior was able to be reviewed, which showed possible right upper lobe abscess. CONCLUSIONS Most pericardial effusions in cancer patients are related to their malignancy, either due to direct metastasis or secondary physiologic effects. This case is a unique example of a lung cancer patient presenting with a pneumococcal pericardial effusion, which in itself is a rare phenomenon. This case report demonstrates the importance of considering early antibiotic therapy in patients presenting with pericardial effusion, especially given the high mortality rates of infectious pericardial effusions.
authors.affiliation: Department of Internal Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Khushboo
authors.initials: K
authors.lastname: Goel
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Huthayfa
authors.initials: H
authors.lastname: Ateeli
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Arizona, Southern Arizona VA Health Care System, Tucson, AZ, USA.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ampel
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Southern Arizona VA Health Care System, Tucson, AZ, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: L'heureux
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004562:Electrocardiography; D006801:Humans; D008169:Lung Abscess / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D020519:Pericardiocentesis; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents