Cortés-Ramírez JM , Cortés-de la Torre JMJ, Cortés-de la Torre RA, Ramirez-Rodríguez M, Toribio-Domínguez B, Torres-Hernández JA, Campos-Candelas MG, de la Torre-Murillo R, Rodríguez-Guajardo A , de la Cruz-Dávila JA, Martínez-Orenday IO

Language: Spanish
References: 11
Page: 106-109
PDF size: 648.87 Kb.

ABSTRACT

Pericarditis can be of infectious, neoplastic and immunological origin or secondary to hypoparathyroidism, uremia and dialysis. The tamponade are common in neoplastic, tuberculous and uremic pericarditis and in myxedema and parasitic diseases. Most organisms causing purulent pericarditis are grampositive and few gramnegative. It is uncommon in adults, but when it occurs it has a high mortality, 40% in treated patients fatal if left untreated due to cardiac tamponade, toxicity and constriction. Klebsiella pneumoniae is an emerging pathogen with high nosocomial spread. Its risk factors for appearance are: prolonged hospitalizations, prior administration of antimicrobials, immunosuppression, chronic diseases, excessive alcohol consumption, rheumatoid arthritis, heart surgery and chest trauma. Purulent pericarditis is usually a complication from infection of contiguous tissue or hematogenous spread. The picture is of an acute and fulminant infection. Pericardiocentesis should be performed promptly with a mortality of 8%, preferable pericardial window. This paper reports the case of a 52-year-old female patient, with mother and grandmother with breast cancer, nubile, with breast cancer, left radical mastectomy five years ago, followed by radiotherapy and chemotherapy, one month before last scheme, with bony, liver, axillary and neck metastases. Patient assisted with gastroenteritis, dyspnea, orthopnea, edema of lower limbs, cough, myalgia, arthralgia, and malaise. Multinodular tele-ray shows diffuse bilateral infiltrates and pleural effusion with cardiac silhouette image of “bottle”. By bilateral transthoracic echocardiogram pleural effusion and tamponade were detected, pericardial window was performed draining 1,100 cc of serosanguineous fluid. Pathology study did not showed tumor cells but did Klebsiella, which was also found in uro and blood culture. Patient showed clinical improvement with treatment and was discharged.

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