SECONDARY BACTERIAL PERICARDITIS WITH CARDIAC TAMPONADE AFTER ENDOBRONCHIAL ULTRASOUND WITH TRANSBRONCIAL NEEDLE ASPIRATION

Document Type

Conference Proceeding

Publication Date

6-23-2023

Publication Title

J Gen Intern Med

Abstract

CASE: A 44-year-old male without signficant past medical history underwent endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) for an incidentally identified subcarinal mass. He later presented with pleuritic chest pain and shortness of breath. CT imaging demonstrated enlargement of the subcarinal mass with a trace pericardial effusion. The patient was planned to undergo repeat EBUS-TBNA, however, he quickly developed hemodynamic instability. Echocardiogram revealed a pericardial effusion with evidence of tamponade. Emergent pericardiocentesis was performed with placement of a pericardial drain, purulent fluid was obtained. Videoassisted thoracoscopic surgery (VATS) was performed with mediastinal washout and pericardial window. Fluid cultures returned positive for S. aureus and Capnocytophaga. IMPACT/DISCUSSION: Bacterial pericarditis is a rare cause of pericarditis; in cases of secondary bacterial pericarditis, Staphylococcus Aureus is the most commonly implicated bacteria. Pericarditis is a known procedural complication of EBUS-TBNA. Given our patient's hemodynamic instability in the setting of cardiac tamponade, emergent pericardiocentesis was indicated. VATS was selected as the treatment modality of choice over subxiphoid pericardotomy, the standard of care, in order to achieve optimal source control by marsupialization of the bronchogenic cyst and completion of a mediastinal washout. Infectious disease was consulted given the atypical growth of Capnocytophaga and S. Aureus for which he was initially treated with Vancomycin and Piperacillin-Tazobactam then transitioned to Amoxicillin- Clavulanate to complete a 6-week treatment course. It was determined that Capnocytophagia was likely introduced to the patient's respiratory system by his dog licking the patient's face. Colchicine was administered for treatment of pericarditis in line with the current guideline recommendations. CONCLUSION: We present an uncommon case of Capnocytophaga bacterial pericarditis leading to cardiac tamponade. The occurrence of pericarditis after EBUS-TBNA is well-documented and clinicians should have a high index of suspicion in patients who become hemodynamically unstable within 3 months of the procedure. In cases of post-procedural bacterial pericarditis, it is important to take a multidisciplinary approach to determine the best treatment course.

Volume

38

Issue

Suppl 3

First Page

S529

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