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Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report

INTRODUCTION: 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. CASE PRESENTATION: A 67-year-old male presents to the Emergency Department with complaints of...

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Autores principales: Chand, Gaurav, Jhaj, Ruby, Sanam, Kumar, Sinha, Prabhat, Alexander, Patrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840289/
https://www.ncbi.nlm.nih.gov/pubmed/27141304
http://dx.doi.org/10.1016/j.amsu.2016.03.024
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author Chand, Gaurav
Jhaj, Ruby
Sanam, Kumar
Sinha, Prabhat
Alexander, Patrick
author_facet Chand, Gaurav
Jhaj, Ruby
Sanam, Kumar
Sinha, Prabhat
Alexander, Patrick
author_sort Chand, Gaurav
collection PubMed
description INTRODUCTION: 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. CASE PRESENTATION: 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. DISCUSSION: 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.
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spelling pubmed-48402892016-05-02 Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report Chand, Gaurav Jhaj, Ruby Sanam, Kumar Sinha, Prabhat Alexander, Patrick Ann Med Surg (Lond) Case Report INTRODUCTION: 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. CASE PRESENTATION: 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. DISCUSSION: 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. Elsevier 2016-03-29 /pmc/articles/PMC4840289/ /pubmed/27141304 http://dx.doi.org/10.1016/j.amsu.2016.03.024 Text en © 2016 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Chand, Gaurav
Jhaj, Ruby
Sanam, Kumar
Sinha, Prabhat
Alexander, Patrick
Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title_full Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title_fullStr Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title_full_unstemmed Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title_short Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report
title_sort pericardial salmonella with cardiac tamponade and ventricular wall rupture: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840289/
https://www.ncbi.nlm.nih.gov/pubmed/27141304
http://dx.doi.org/10.1016/j.amsu.2016.03.024
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