23 May 2023 : Case report
[In Press] From the Gut to the Heart: A Rare Case of Salmonella dublin Pericarditis
Rare diseaseKunjal Patel1ABCDEF, Brittni McClellan1BCDEF, Jared Steinberger2BCDE, Delano Small2E, Alehegn Gelaye3E
Am J Case Rep In Press; DOI: 10.12659/AJCR.939927
Available online: 2023-05-23, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Salmonella infections manifest typically as self-limiting gastroenteritis after the consumption of contaminated food. Extra-intestinal manifestations of Salmonella infections such as pericarditis are rare and are usually seen in severely immunocompromised individuals. Prior case reports suggest high rates of morbidity and mortality associated with Salmonella pericarditis. Here, we present a rare case of Salmonella dublin pericarditis.
A 45-year-old man presented to the Emergency Department reporting chest pressure and shortness of breath. An echocardiogram showed a large pericardial effusion without tamponade physiology. Pericardial window was performed, with removal of 700 cubic centimeters of bloody fluid, with presence of fibrinous debris in the pericardial cavity. A pericardial biopsy showed chronic pericarditis, and a lymph node biopsy was negative for malignancy. Antinuclear antibody (ANA), Lyme antibodies, and human immunodeficiency virus (HIV) testing were negative. Tissue culture revealed Salmonella species. Subsequent blood cultures grew Salmonella spp. Further history-taking revealed frequent travel and recent treatment with steroids for suspected Bell’s palsy. Initially, the patient was treated with ceftriaxone, which was switched to ciprofloxacin after susceptibility testing revealed ceftriaxone resistance. Final identification of the organism revealed Salmonella dublin. The patient was discharged on colchicine, ibuprofen, and a 4-week course of ciprofloxacin. Outpatient follow-up showed improvement in inflammatory markers and symptoms.
This case illustrates the rarity of Salmonella-associated pericarditis, the importance of assessing a patient’s risk factors, and obtaining an extensive history when searching for an etiology of pericarditis. Investigation into why a patient was susceptible to an infection with this organism should include medication assessment and age-appropriate cancer screening. Prompt identification and treatment of the offending organism can help prevent mortality.
Keywords: AvrA protein, Salmonella dublin; Pericarditis; Pericardial Effusion
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