Asunto(s)
Fibrilación Atrial , Dolor en el Pecho , Staphylococcus aureus Resistente a Meticilina , Pericarditis , Infecciones Estafilocócicas , Abuso de Sustancias por Vía Intravenosa , Anciano , Humanos , Masculino , Enfermedad Aguda , Antibacterianos/uso terapéutico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Dolor en el Pecho/etiología , Dolor en el Pecho/terapia , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Fentanilo , Trastornos Inducidos por Narcóticos/complicaciones , Líquido Pericárdico/microbiología , Pericardiocentesis , Pericarditis/diagnóstico , Pericarditis/microbiología , Pericarditis/terapia , Pericarditis Constrictiva , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/terapia , Abuso de Sustancias por Vía Intravenosa/complicaciones , Supuración/microbiología , Supuración/terapia , Personas con Mala Vivienda , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológicoRESUMEN
A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.
Asunto(s)
Infecciones por Erysipelothrix , Erysipelothrix , Pericarditis , Anciano , Ecocardiografía , Infecciones por Erysipelothrix/diagnóstico , Infecciones por Erysipelothrix/microbiología , Humanos , Huésped Inmunocomprometido , Masculino , Líquido Pericárdico/microbiología , Pericarditis/diagnóstico , Pericarditis/microbiología , Pericardio/diagnóstico por imagenAsunto(s)
Adenosina Desaminasa/análisis , Líquido Pericárdico/química , Pericarditis Tuberculosa/diagnóstico , Anciano , Antituberculosos/uso terapéutico , Disnea/etiología , Edema/etiología , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Neutrófilos , Derrame Pericárdico/microbiología , Líquido Pericárdico/citología , Líquido Pericárdico/microbiología , Pericarditis Tuberculosa/tratamiento farmacológicoRESUMEN
Mycobacterium tuberculosis can spread through the entire body but rarely involves the eye. We report a patient with endophthalmitis in one eye and simultaneous retinal vasculitis in the fellow eye. Systemic work-up suggested infective endopericarditis. Polymerase chain reaction analyses of the vitreous and pericardial fluid were positive for M. tuberculosis. We initiated a four-drug antituberculous treatment regimen (isoniazid, ethambutol, pyrazinamide, and rifampin). After two weeks, we discontinued all the medications due to drug-induced hepatitis. We restarted isoniazid and rifampin, but hepatitis recurred. Finally, we chose isoniazid/ethambutol combination for 18 months, and also administered short-term systemic corticosteroid. His vision improved considerably with no recurrence of hepatitis or tuberculosis for 3 years after completion of treatment. Ocular tuberculosis can masquerade as other causes of intraocular inflammation, and a medical team consisting of an ophthalmologist and an infectious disease specialist might be needed for the diagnosis and management.
Asunto(s)
Endocarditis/diagnóstico , Pericarditis/diagnóstico , Tuberculosis Ocular/diagnóstico , Uveítis/diagnóstico , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Endocarditis/tratamiento farmacológico , Endocarditis/microbiología , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Líquido Pericárdico/microbiología , Pericarditis/tratamiento farmacológico , Pericarditis/microbiología , Vasculitis Retiniana/diagnóstico , Vasculitis Retiniana/tratamiento farmacológico , Vasculitis Retiniana/microbiología , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/microbiología , Uveítis/tratamiento farmacológico , Uveítis/microbiología , Cuerpo Vítreo/microbiologíaRESUMEN
A 58-year-old man presented with tamponade and underwent an emergency pericardiocentesis. We made the diagnosis of methicillin-resistant Staphylococcus aureus pericarditis based on culture results and treated the patient with pericardial drainage and antibiotics as the first-line therapy. After temporary relief, reaccumulation of effusion developed. We successfully created a pericardial window using thoracotomy, and the patient's postoperative course was uneventful. Methicillin-resistant Staphylococcus aureus pericarditis is an extremely rare and life-threatening illness. No consensus exists concerning the ideal surgical intervention. Creating a pericardial window using thoracotomy can be an effective definitive therapy for methicillin-resistant Staphylococcus aureus pericarditis, especially for patients with significant pericardial adhesions.