A case study highlighted the importance of undergoing a comprehensive diagnostic work-up for bacterial pericarditis. The results were published in The American Journal of Case Reports.
This report described a 34-year-old man who presented with fever, cough, and night sweats. The patient’s diagnosis was initially delayed without a tissue sample, and he was discharged on RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) and steroids for presumed tuberculosis pericarditis. However, his conditioned worsened, and he was readmitted to the hospital with evolving pericardial effusion with air present, in addition to new pleural effusion and parenchymal consolidation. The patient subsequently underwent thoracotomy and pericardial biopsy. Tissue cultures and sequence-based bacterial analysis eventually revealed polymicrobial bacterial pericarditis. His conditioned improved dramatically with appropriate antibiotic therapy.
The researchers summarized that this case study “demonstrates the importance of undergoing further diagnostic work-up for bacterial pericarditis, especially in resource-rich settings. Although tuberculosis pericarditis should remain high on the differential, it is imperative not to anchor on that diagnosis. Instead, when feasible and safe, tissue biopsy should be obtained and sent for organism identification. Acid-fast bacilli smears and cultures, Xpert MTB/RIF, and sequence-based bacterial analysis have all been used for identification. Delay in diagnosis can lead to progression of disease and unnecessary incorrect therapies.”
Keywords: bacterial pericarditis, antibiotic therapy, tuberculosis pericarditis