JACC. Case reports · 2026
Purulent Pericarditis After Esophageal Erosion With Streptococcus intermedius and Lactobacillus spp.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Madishetty Vineet, Yaylayan Alexander, Handa Armaan, Colafranceschi Alexandre, Halleman Christopher
Аннотация
BACKGROUND: Purulent pericarditis is rare but rapidly fatal without urgent drainage and targeted antibiotics; malignancy-related effusions should not be presumed malignant when an anatomic breach is possible.
CASE PRESENTATION: A 67-year-old male with esophageal squamous cell carcinoma presented with pleuritic chest pain. Electrocardiogram showed diffuse ST elevation; transthoracic echocardiography revealed a large effusion with fibrinous strands and mild right-ventricle diastolic collapse. Computed tomography angiography demonstrated tumor erosion into the left main bronchus. The patient received vancomycin/piperacillin-tazobactam and underwent emergent pericardiocentesis yielding ∼800 mL of cloudy fluid (49,710 cells/μL, glucose 2 mg/dL, lactate dehydrogenase 7,327 U/L; neutrophil predominant; cytology negative; blood cultures returned negative). Cultures grew Streptococcus intermedius and Lactobacillus spp; antibiotics were narrowed to intravenous ceftriaxone for 3 weeks. Persistent tamponade necessitated pericardial window placement on hospital day 4; follow-up echocardiography demonstrated improved effusion with pericardial thickening/calcification.
DISCUSSION: In malignancy, diffuse ST elevation and highly inflammatory fluid should prompt evaluation for purulence and an anatomic breach rather than anchoring on malignant effusion.
TAKE-HOME MESSAGE: In cancer patients with pericardial effusion, oral/gastrointestinal flora in pericardial cultures should trigger evaluation for an anatomic breach (eg, tumor erosion) and early source control with drainage, culture-directed antibiotics, and surgical escalation when tamponade continues to persist.
CASE PRESENTATION: A 67-year-old male with esophageal squamous cell carcinoma presented with pleuritic chest pain. Electrocardiogram showed diffuse ST elevation; transthoracic echocardiography revealed a large effusion with fibrinous strands and mild right-ventricle diastolic collapse. Computed tomography angiography demonstrated tumor erosion into the left main bronchus. The patient received vancomycin/piperacillin-tazobactam and underwent emergent pericardiocentesis yielding ∼800 mL of cloudy fluid (49,710 cells/μL, glucose 2 mg/dL, lactate dehydrogenase 7,327 U/L; neutrophil predominant; cytology negative; blood cultures returned negative). Cultures grew Streptococcus intermedius and Lactobacillus spp; antibiotics were narrowed to intravenous ceftriaxone for 3 weeks. Persistent tamponade necessitated pericardial window placement on hospital day 4; follow-up echocardiography demonstrated improved effusion with pericardial thickening/calcification.
DISCUSSION: In malignancy, diffuse ST elevation and highly inflammatory fluid should prompt evaluation for purulence and an anatomic breach rather than anchoring on malignant effusion.
TAKE-HOME MESSAGE: In cancer patients with pericardial effusion, oral/gastrointestinal flora in pericardial cultures should trigger evaluation for an anatomic breach (eg, tumor erosion) and early source control with drainage, culture-directed antibiotics, and surgical escalation when tamponade continues to persist.