Korean J Nephrol.
2010 Jan;29(1):162-166.
Acute Purulent Staphylococcal Pericarditis with Cardiac Tamponade in a Hemodialysis Patient
- Affiliations
-
- 1Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea. jwdr@hanmail.net
- 2Hallym Kidney Research Institute, College of Medicine, Hallym University, Seoul, Korea.
Abstract
- Purulent pericarditis is a rare disease in both end-stage renal disease (ESRD) patients and the general population. We report herein a case of acute purulent staphylococcal pericarditis with cardiac tamponade managed by intravenous antibiotics and pericardiocentesis with drainage. A 54-year-old man with ESRD, who had been on hemodialysis (HD) for the previous six months, was admitted to the hospital because of fever. He had a history of a recent episode of staphylococcal bacteremia associated with venography for arteriovenous fistula (AVF) malfunction. On the sixth day after admission, severe intradialytic hypotension arose during HD. Echocardiography showed a large pericardial effusion with hemodynamic significance. Emergency pericardiocentesis with drainage was performed. Acute purulent staphylococcal pericarditis with cardiac tamponade was diagnosed and intravenous vancomycin was administered for four weeks. On the 23rd day, the patient was discharged from the hospital after the drainage catheter's removal. Ten days after discharge, however, he was re-admitted because of dyspnea on exertion. Eventually, the patient expired because of heart failure caused by progressive constrictive pericarditis. We suggest that acute purulent pericarditis should be considered in dialysis patients who develop fever and severe hypotension during HD, especially after known staphylococcal infections.
MeSH Terms
-
Anti-Bacterial Agents
Arteriovenous Fistula
Bacteremia
Cardiac Tamponade
Dialysis
Drainage
Dyspnea
Echocardiography
Emergencies
Fever
Heart Failure
Hemodynamics
Humans
Hypotension
Kidney Failure, Chronic
Middle Aged
Pericardial Effusion
Pericardiocentesis
Pericarditis
Pericarditis, Constrictive
Phlebography
Rare Diseases
Renal Dialysis
Staphylococcal Infections
Vancomycin
Anti-Bacterial Agents
Vancomycin
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