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19 March 2018 : Case report  Malaysia

A Case of Constrictive Pericarditis Associated with Melioidosis in an Immunocompetent Patient Treated by Pericardiectomy

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment

Hou Tee Lu12ABDEF*, Gunasekaran Ramsamy2DF, Chuey Yan Lee2DE, Syed Rasul G. Syed Hamid3BDF, Foong Kee Kan4DEF, Rusli Bin Nordin1EF

DOI: 10.12659/AJCR.908310

Am J Case Rep 2018; 19:314-319

Abstract

BACKGROUND: Melioidosis is a rare tropical bacterial infection caused by the Gram-negative soil saprophyte, Burkholderia pseudomallei. Melioidosis can mimic a variety of diseases due to its varied presentation, and unless it is treated rapidly, it can be fatal.  A rare case of melioidosis, with pericarditis and pericardial effusion, is described, which demonstrates the value of early diagnosis with echocardiography and pericardiocentesis.

CASE REPORT: A 38-year-old native (Iban) East Malaysian man presented with shortness of breath and tachycardia. Transthoracic echocardiography (TTE) showed cardiac tamponade. Urgent pericardiocentesis drained a large amount of purulent pericardial fluid that grew Burkholderia pseudomallei. Despite appropriate dose and duration of intravenous treatment with ceftazidime followed by meropenem, the patient developed recurrent pericardial effusion and right heart failure due to constrictive pericarditis. The diagnosis of constrictive pericarditis was confirmed by computed tomography (CT) and surgical exploration. Following pericardiectomy, his symptoms resolved, but patient follow-up was recommended for possible sequelae of constrictive pericarditis.

CONCLUSIONS: After the onset of melioidosis pericarditis, the authors recommend follow-up and surveillance for possible complication of constrictive pericarditis.

Keywords: Echocardiography, Melioidosis, Pericardiectomy, Pericardiocentesis, Pericarditis, Constrictive

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923