SHM Converge Scientific Abstract ePoster Gallery-A Hunka, Hunka Burnin' Heart

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This case report describes a 33-year-old previously healthy man who presented after a severe gastrointestinal illness with fever, diffuse joint pain, myalgias, weakness, and difficulty walking. He had marked inflammation, acute kidney injury, thrombocytopenia, and positive blood cultures for <em>Haemophilus influenzae</em>. He was initially treated with IV ceftriaxone.

During hospitalization, he developed dyspnea and pleuritic chest pain after fluid resuscitation. EKG showed diffuse ST-segment elevations, and echocardiography revealed a large loculated pericardial effusion with tamponade physiology. Emergent pericardiocentesis removed 600 mL of purulent fluid, and he later required pericardiectomy. He completed 14 days of ceftriaxone and recovered after discharge to rehabilitation and then home.

Subsequent evaluation revealed previously undiagnosed HIV infection, with a CD4 count of 256/mm³ and a viral load of 25,000 copies/mL. He was started on antiretroviral therapy, and at two-month follow-up his viral load was undetectable and CD4 count improved.

The discussion emphasizes that purulent pericarditis is rare in the antibiotic era but remains a medical emergency. Common causes include <em>Staphylococcus aureus</em>, <em>Streptococcus</em> species, <em>Haemophilus</em>, and <em>Mycobacterium tuberculosis</em>. Classic pericarditis symptoms are absent in many patients, making diagnosis challenging. Mortality is high without treatment and remains substantial even with intervention.

The report concludes that clinicians should consider bacterial pericarditis in febrile patients with chest pain, even when classic features are missing, and that isolation of unusual organisms should prompt evaluation for underlying immunodeficiency such as HIV.

Asset Subtitle

Kassidy Lovins

Meta Tag

Author List Emily Sturkie, Jennifer J. McEntee, John R. Stephens, Kassidy Lovins

Category Clinical Vignettes

Concept Purulent Bacterial Pericarditis

Concept Cardiac Tamponade

Concept Pericardiocentesis

Concept Pericardial Effusion

Concept Haemophilus influenzae

Distinguished Finalist

Presenter Organization University of North Carolina at Chapel Hill School of Medicine

Presenting Author Kassidy Lovins

Track Adult

Keywords

purulent pericarditis

Haemophilus influenzae

HIV infection

pericardial tamponade

pericardiocentesis

pericardiectomy

bacterial pericarditis

acute kidney injury

ceftriaxone

immunodeficiency

Purulent Bacterial Pericarditis

Cardiac Tamponade

Pericardiocentesis

Pericardial Effusion

Haemophilus influenzae