A Rare Case of Acute Purulent Myopericarditis Due To Klebsiella Pneumoniae

Challenge in Diagnosis and Management

Background: Acute purulent myopericarditis caused by Klebsiella pneumoniae is a rare condition in the modern antibiotic era. It can progress to pericardial effusion that can cause a life-threatening cardiac tamponade. The typical manifestation of myopericarditis may be absent and possess significant challenge in diagnosis and treatment. This article is conducted to report a case of acute purulent myopericarditis caused by of Klebsiella pneumoniae that are barely reported.

Case Summary: Male, 52 years-old, presented with prolonged fever, progressive dyspnea and palpitation. The physical and supporting examination only shown the clinical symptoms of thyroid storm, heart failure, and coronary artery disease. After 2 days of treatment, he developed cardiac tamponade. Purulent mixed hemorrhagic fluid was evacuated from pericardiocentesis with positive culture for Klebsiella pneumoniae sensitive for ceftriaxone. Ceftriaxone, ibuprofen, and colchicine were given.

Conclusion: Myopericarditis should always kept in mind as differential diagnosis in patient with pericardial effusion and when it rapidly deteriorated, purulent bacterial infection although rare could be the possible cause. Prompt intervention through fluid evacuation, adequate antibiotic therapy and surgical pericardiectomy when indicated, were needed to improve disease outcome.