Cardiac tamponade secondary to purulent pericarditis diagnosed with the aid of emergency department ultrasound.

Purulent pericarditis is a rare but devastating disease process and even when treated, carries a poor prognosis. Cardiac tamponade is the most severe complication of purulent pericarditis and without acute surgical intervention, is often fatal. Diagnosis requires pericardiocentesis; however, early consideration of the disease and its complications in the emergency department (ED) can be life-saving. Here, we present a case of an intravenous drug user who presented with altered mental status and a rectal temperature of 105.4°. While in the ED, the patient acutely decompensated. The ED physician performed bedside cardiac ultrasound that a showed pericardial effusion and right ventricle diastolic collapse concerning for cardiac tamponade. The patient underwent urgent pericardiocentesis which revealed 300 ml of purulent fluid. Both blood and pericardial cultures grew methicillin-sensitive Staphylococcus aureus. Despite a complicated hospital course, with appropriate antibiotic coverage and surgical intervention, the patient was discharged in good neurologic condition. This rare case of purulent pericarditis underscores the utility of bedside ultrasound in the ED and the complicated nature of altered mental status in intravenous drug users.