Methicillin-Sensible Staphylococcus aureus (MSSA) Pericardial Effusion Causing Cardiac Tamponade: A case report

Background: Methicillin-Sensible Staphylococcus aureus (MSSA) as the pathogen of the pericardial space is an uncommon case that can be fatal if untreated. The underlying disease accompany with infection that lead to cardiac tamponade can increase mortality rate of the patient.

Case description: We present a 29 years old male patient with severe dispnea who was found to have cardiac tamponade secondary to a purulent pericardial effusion. He was also had end stage renal disease with regular hemodialysis. The diagnosis was suggested by clinical context, imaging, pericardial fluid analysis and was confirmed by culture. MSSA were isolated from 2 times pericardial fluid, peripheral blood and double lumen catheter exit site swab that were growth in blood agar only. Identification and susceptibility to antibiotics was assessed by Vitek2 Compact automated system (BioMerieux), represent sensitive to penicillin, cephalosporin, quinolone, aminoglycoside except macrolides. Administration of cefazolin intravenous for 5 days and also pericardial drainage result in a full recovery for the patient.

Discussion: Purulent pericardial effusion is a rare condition that carries a high mortality rate as it can rapidly progress into cardiac tamponade. In developing countries, Mycobacterium tuberculosis is the most frequent cause of acute pericarditis followed by Haemophilus, Staphylococcus and Streptococcus. Prior to the advent of antibiotics, Staphylococcus aureus takes role as the predominant pathogen, this event was common as the result of hematogenous seeding such as catheter related hemodialysis in this patient.

Conclusion: Prompt diagnosis of purulent pericardial effusion also initiation of appropriate antibiotic and pericardial drainage treatment are the mainstays of successful management of this rare but potentially lethal case.