Scientific letter
Purulent pericarditis by Staphylococcus Panton-Valentine secondary to hair implants
Pericarditis purulenta por Estafilococo Panton-Valentine secundaria a implantes de cabello
Leydimar Anmad Shihadeh
, Patricia Couto Comba, Carolina Hernández Carballo
Corresponding author
Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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The clinical signs and symptoms are very serious and usually progress to cardiac tamponade (CT) or is the first clinical manifestation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> We report a rare case of PP in the medical literature. On the one hand, we would like to emphasize the importance of a thorough physical examination in this type of entity to recognize where the initial infection site may be, and on the other, that immediate action is paramount and largely determines the prognosis. Clinical suspicion and multidisciplinary approach are essential.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 29-year-old woman with a history of type 2 diabetes mellitus comes to our hospital for chest pain that increases in decubitus position and improves when sitting. Physical examination revealed normal vesicular breath sounds. Cardiac rhythm with no murmur or rubbing, electrocardiogram with diffuse ST segment elevation and echocardiogram<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> with PE, without haemodynamic compromise data; diagnosed of acute pericarditis and subsequent treatment with ibuprofen and colchicine. Likewise, data on diabetic ketoacidosis were obtained. The patient denied diarrhoea, respiratory tract or other clinical symptoms, as well as febrile illness.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Evidence of metabolic acidosis persisted during her hospital stay, with a pH of up to 7.10 and HCO<span class="elsevierStyleInf">3−</span> of 5; renal function and oligoanuria worsened; upon re-interviewing the patient, she reported multiple abscesses on the scalp of 2–3 weeks of evolution secondary to hair implants, with outflow of pus following manipulation, so that empiric antibiotic treatment was initiated. In addition, hypoxaemic respiratory failure was observed with respiratory work. A control echocardiogram was performed after 36<span class="elsevierStyleHsp" style=""></span>h, with persistence of effusion, abundant fibrin and with data of increased pulmonary pressure and severe right ventricle dysfunction and mild in the left ventricle. On physical examination: blood pressure 96/43<span class="elsevierStyleHsp" style=""></span>mmHg, heart rate 107<span class="elsevierStyleHsp" style=""></span>bpm in sinus rhythm. SatO<span class="elsevierStyleInf">2</span> levels of 89% with face mask, conscious, oriented, with mucocutaneous dehydration and a certain generalized pallor, had 2 abscesses in the scalp (left occipitoparietal and right occipital) with pus and blood suppuration. Normal vesicular breath sounds, with no added sounds, with some thoracoabdominal imbalance. Rhythmic cardiac sounds, no murmurs were heard. The following concentrations stood out in the lab tests: glucose 107<span class="elsevierStyleHsp" style=""></span>mg/dl, urea 100<span class="elsevierStyleHsp" style=""></span>mg/dl, creatinine 2.53<span class="elsevierStyleHsp" style=""></span>mg/dl, sodium 126<span class="elsevierStyleHsp" style=""></span>mmol/l, potassium 4.56<span class="elsevierStyleHsp" style=""></span>mmol/l, AST/ALT 44/39<span class="elsevierStyleHsp" style=""></span>U/l, Hb 9.8<span class="elsevierStyleHsp" style=""></span>G/dl, Hcrt 29.7%, white blood cells 15.590/mm<span class="elsevierStyleSup">3</span> (N: 81%, L: 9.2%). Coagulation: CT 11.3, 100% ATP, INR 0.99.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Following these findings, the patient was transferred to the Intensive Care Unit, where pericardiocentesis was performed: purulent fluid, blood cultures, secretion cultures. Subsequently, she was prone to arterial hypotension, developing cardiopulmonary arrest (CPA), which led to orotracheal intubation and vasoactive amine initiation. A body CT-scan was performed, highlighting: Large PE with signs of superinfection; right-sided predominance bilateral pleural effusion; diffuse oedema of the subcutaneous cellular tissue and abundant amount of free abdominopelvic fluid with congestive hepatopathy. The results of the cultures were obtained, MRSA linked to Panton-Valentine toxin was isolated in the exudate samples of scalp wound, pericardium, urine and blood. Despite the intensive treatment, the patient remained hemodynamically unstable, with PE data, so a pericardiectomy was performed, in which abundant fibrin content was obtained, covering the pericardial cavity with a yellowish-green colour. PE aspirate was cloudy, leaving a thick layer of fibrin that was released by areas, which could amount to a total volume of about 50–60<span class="elsevierStyleHsp" style=""></span>ml. Following a clinical, haemodynamic and laboratory-parameters improvement, the patient was transferred to Intermediate Care, where, after 48<span class="elsevierStyleHsp" style=""></span>h, developed respiratory and haemodynamic deterioration, with a new CPA. She was intubated and transferred to the Intensive Care Unit, where, despite the intensive measures, died.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the present case, the patient developed bacteraemia secondary to dermal infection, therefore, the pericardium could have been infected through blood, this form of pericardial contamination has already been described. Staphylococcal pericarditis is extremely severe and acute. The diagnosis of certainty was obtained through pericardiocentesis. Finally, it is necessary to emphasize the high mortality associated with this entity, despite the early and intensive treatment it requires.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Anmad Shihadeh L, Couto Comba P, Hernández Carballo C. Pericarditis purulenta por Estafilococo Panton-Valentine secundaria a implantes de cabello. Med Clin (Barc). 2017;148:525.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Purulent pericarditis: a rare diagnosis Portuguese" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Ferreira dos Santos" 1 => "D. Moreira" 2 => "P. Ribeiro" 3 => "B. Rodrigues" 4 => "E. Correia" 5 => "L. Nunes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2013.07.003" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "721" "paginaFinal" => "727" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24011667" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiographically guided pericardiocentesis – the gold standard for the management of pericardial effusion and cardiac tamponade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Salem" 1 => "A. Mulji" 2 => "E. Lonn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "1999" "volumen" => "15" "paginaInicial" => "1251" "paginaFinal" => "1255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10579740" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000011/v1_201706250038/S2387020617303340/v1_201706250038/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000011/v1_201706250038/S2387020617303340/v1_201706250038/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303340?idApp=UINPBA00004N" ]
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