Pyopericarditis and tropical pyomyositis: unusual concomitance

Ano: 2012 | Volume: 2 | Número: 1

Autores: P. H. M. C. Melo, H. L. Staniak, A. Felipe-Silva, I. S. Santos, M. S. Bittencourt

Palavras-chave: pericarditis, chest pain, tropical myositis, staphylococcus aureus

Resumo Inglês:

The authors report a case of a 19-year-old male who presented to the
emergency room complaining of chest pain. His physical examination was
unremarkable, but the EKG showed PR deviation and ST segment elevation.
The patient was diagnosed as probable viral pericarditis and was prescribed
oral anti-inflammatories. After 3 days he returned, complaining of chest pain
worsening, generalized muscle pain and fever. Laboratory examinations
showed creatine kinase isoenzyme MB (CK-MB) = 89.5 ng.mL–1 and C-Reactive
Protein (CRP) = 391 mg.L–1. Echocardiogram showed pericardial thickening
but no pericardial effusion was present. During admission the patient evolved
with cardiac tamponade. Empirical ceftriaxone and oxacillin were started and
the patient underwent pericardial surgical drainage. Staphylococcus aureus
was isolated from the pericardial effusion. After 7 days the patient started
complaining of leg pain, and fever recurred. Computed tomography of the
lower limbs identified large muscle commitment compatible with the presence
abscesses. These findings were suggestive of staphylococcal tropical
myositis. The patient was treated with abscesses drainage and oxacillin. He
was discharged after 18 days to complete oral antibiotic therapy.