Cargando…

Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report

Patient: Male, 34-year-old Final Diagnosis: Pericarditis Symptoms: Chest pain • cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Mistake in diagnosis BACKGROUND: Bacterial pericarditis can present a diagnostic challenge due to the diff...

Descripción completa

Detalles Bibliográficos
Autores principales: Carmack, Anna E., LaRocco, Allison M., Mathew, Minu, Goldberg, Hannah V., Patel, Devang M., Saleeb, Paul G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607027/
https://www.ncbi.nlm.nih.gov/pubmed/34782592
http://dx.doi.org/10.12659/AJCR.933684
_version_ 1784602466711502848
author Carmack, Anna E.
LaRocco, Allison M.
Mathew, Minu
Goldberg, Hannah V.
Patel, Devang M.
Saleeb, Paul G.
author_facet Carmack, Anna E.
LaRocco, Allison M.
Mathew, Minu
Goldberg, Hannah V.
Patel, Devang M.
Saleeb, Paul G.
author_sort Carmack, Anna E.
collection PubMed
description Patient: Male, 34-year-old Final Diagnosis: Pericarditis Symptoms: Chest pain • cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Mistake in diagnosis BACKGROUND: Bacterial pericarditis can present a diagnostic challenge due to the difficulty of obtaining tissue for bacterial identification. This report is of a 34-year-old man who presented with fever and cough. Diagnosis was initially delayed without a tissue sample, but the patient was later found to have polymicrobial bacterial pericarditis. CASE REPORT: A 34-year-old man from the Democratic Republic of Congo presented to the emergency room with cough, fever, and night sweats. He was admitted and found to have pericardial thickening and fluid collection with calcifications. A tissue sample was not obtained for diagnosis, and he was discharged on RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) and steroids for presumed tuberculosis pericarditis. He worsened clinically and was readmitted to the hospital with evolving pericardial effusion with air present, in addition to new pleural effusion and parenchymal consolidation. He subsequently underwent thoracotomy and pericardial biopsy. Tissue cultures and sequence-based bacterial analysis eventually revealed the presence of Prevotella oris and Fusobacterium nucleatum. He improved dramatically with appropriate antibiotic therapy. CONCLUSIONS: This report demonstrates the importance of undergoing further diagnostic work-up for bacterial pericarditis, especially in resource-rich settings. Although tuberculosis pericarditis should remain high on the differential, it is imperative not to anchor on that diagnosis. Instead, when feasible and safe, tissue biopsy should be obtained and sent for organism identification. AFB smears and cultures, Xpert MTB/RIF, and sequence-based bacterial analysis have all been used for identification. Delay in diagnosis can lead to progression of disease and unnecessary incorrect therapies.
format Online
Article
Text
id pubmed-8607027
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher International Scientific Literature, Inc.
record_format MEDLINE/PubMed
spelling pubmed-86070272021-12-09 Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report Carmack, Anna E. LaRocco, Allison M. Mathew, Minu Goldberg, Hannah V. Patel, Devang M. Saleeb, Paul G. Am J Case Rep Articles Patient: Male, 34-year-old Final Diagnosis: Pericarditis Symptoms: Chest pain • cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Mistake in diagnosis BACKGROUND: Bacterial pericarditis can present a diagnostic challenge due to the difficulty of obtaining tissue for bacterial identification. This report is of a 34-year-old man who presented with fever and cough. Diagnosis was initially delayed without a tissue sample, but the patient was later found to have polymicrobial bacterial pericarditis. CASE REPORT: A 34-year-old man from the Democratic Republic of Congo presented to the emergency room with cough, fever, and night sweats. He was admitted and found to have pericardial thickening and fluid collection with calcifications. A tissue sample was not obtained for diagnosis, and he was discharged on RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) and steroids for presumed tuberculosis pericarditis. He worsened clinically and was readmitted to the hospital with evolving pericardial effusion with air present, in addition to new pleural effusion and parenchymal consolidation. He subsequently underwent thoracotomy and pericardial biopsy. Tissue cultures and sequence-based bacterial analysis eventually revealed the presence of Prevotella oris and Fusobacterium nucleatum. He improved dramatically with appropriate antibiotic therapy. CONCLUSIONS: This report demonstrates the importance of undergoing further diagnostic work-up for bacterial pericarditis, especially in resource-rich settings. Although tuberculosis pericarditis should remain high on the differential, it is imperative not to anchor on that diagnosis. Instead, when feasible and safe, tissue biopsy should be obtained and sent for organism identification. AFB smears and cultures, Xpert MTB/RIF, and sequence-based bacterial analysis have all been used for identification. Delay in diagnosis can lead to progression of disease and unnecessary incorrect therapies. International Scientific Literature, Inc. 2021-11-16 /pmc/articles/PMC8607027/ /pubmed/34782592 http://dx.doi.org/10.12659/AJCR.933684 Text en © Am J Case Rep, 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Carmack, Anna E.
LaRocco, Allison M.
Mathew, Minu
Goldberg, Hannah V.
Patel, Devang M.
Saleeb, Paul G.
Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title_full Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title_fullStr Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title_full_unstemmed Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title_short Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report
title_sort subacute polymicrobial bacterial pericarditis mimicking tuberculous pericarditis: a case report
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607027/
https://www.ncbi.nlm.nih.gov/pubmed/34782592
http://dx.doi.org/10.12659/AJCR.933684
work_keys_str_mv AT carmackannae subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport
AT laroccoallisonm subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport
AT mathewminu subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport
AT goldberghannahv subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport
AT pateldevangm subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport
AT saleebpaulg subacutepolymicrobialbacterialpericarditismimickingtuberculouspericarditisacasereport