Haemophilus influenzae purulent pericarditis in an immunocompetent individual

Abstract

Purulent pericarditis is a rare bacterial illness in the post-antibiotic era that is defined as pericardial infection with gross or microscopic purulence in the pericardium. Common causes include nosocomial bloodstream infections, direct spread through thoracic surgery, or immunosuppression. We present a case of a 66-year-old male with a history of mantle cell lymphoma status post chemotherapy, completed about 4 years before presentation, in general, good health presented with acute typical chest pain associated with dyspnea on exertion. 12-lead EKG demonstrated ST elevations in anterolateral and lateral leads. Patient was initially being managed as Acute Coronary Syndrome, though, preliminary bedside echocardiogram demonstrated a large pericardial effusion with pretamponade physiology, which was confirmed with a STAT transthoracic echocardiogram. He underwent an emergent pericardial window which drained 350-400 ml of yellow murky pericardial fluid. Blood cultures and pericardial fluid cultures grew Haemophilus influenzae (H. influenzae). Upon further history taking, patient revealed experiencing upper respiratory symptoms and being diagnosed with pansinusitis 2 months before his admission. He was treated with IV ceftriaxone for 4 weeks from the day of negative blood cultures. H. influenzae upper respiratory infection is usually seen in the unvaccinated pediatric population, or in immunocompromised individuals; however, few cases in vaccinated adults have been reported, as in the above case. Sequalae from H. influenzae infection is usually limited to upper respiratory symptoms and mastoiditis, but rarely, pericarditis could occur. It is important to include pericarditis in the differential for chest pain in a patient with a recent history of upper respiratory symptoms. Pericarditis is a rare but potentially serious complication of recent upper respiratory tract infection, and needs to be promptly identified and treated to avoid further morbidity.