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A04500103

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The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications …

The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.

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  • 1. IOSR Journal Of Pharmacy (e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219 www.iosrphr.org Volume 4, Issue 5 (May 2014), PP. 01-03 1 A Case Report Of Suppurative Pericarditis By Henry A Mayala, Levi Kwarisiima, Robert Mvungi, Peter Kisenge, Nyangasa, Nyawawa, Kawajika ABSTRACT Background: Suppurative pericarditis is defined as an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on tissue microscopy. Bacterial infections of the pericardium are relatively uncommon but are much more likely to produce purulent effusions and to proceed to cardiac tamponade and pericardial constriction1 . Case presentation: In this case report a 57 year old lady with confirmed diagnosis SLE on treatment (prednisolone and methotrexate) was admitted at cardiovascular medicine department of Muhimbili national hospital(MNH) with the chief complains of cough, chest pain and difficulty in breathing, with associated history of weight loss. Clinical and imaging findings are suggestive of suppurative pericarditis and it was confirmed and managed by surgical pericardial drainage of 700mls of pus. Conclusion: purulent/suppurative pericarditis should be suspected in ill patients with thoracic infections, patients will often be febrile and tachycardic without a doubt optimal care of these complicated infections requires a multidisciplinary approach2 . Keywords: purulent, suppurative pericarditis, bacteria, CT-scan, pericardial drainage I. INTRODUCTION Purulent pericarditis is defined as an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on tissue microscopy.Bacterial infections of the pericardium are relatively uncommon but are much more likely to produce purulent effusions and to proceed to cardiac tamponade and pericardial constriction1. Purulent pericarditis occurs almost exclusively as a secondary infection in patients with AIDS, and those undergoing hemodialysis, thoracic surgery and chemotherapy.Numerous microbes are capable of causing pericardial infection; viral agents are common identified cause of pericarditis. Viral and idiopathic pericarditis accounts for 90% of cases of acute pericarditis. Coxsackie virus B, adenovirus, Echoviridae and Retroviridae are usually responsible. Bacterial pericarditis is not typically a primary infection but is almost exclussively a complication from an underlying infection. In pre-antibiotic era, patients most frequently developed bacterial pericarditis due to pneumonia with empyema and most common organism was streptoccocus pneumoniae. In the antibiotic era, the most common causative organism was staphylococcus aureus. Recent studies have noted a trend towards involvement of more diverse microbes and anaerobes have been reported as a common cause of pericardial infections. Fungal and tuberculosis also cause purulent pericarditis. The recognized risk factors for purulent pericarditis include: advanced age, diabetes mellitus,untreated infection(pneumonia), extensive burns, and immunosuppressed state.1 Case Presentation: We present a case report of a 57 years old female with confirmed diagnosis SLE on treatment (prednisolone and methotrexate) admitted at Cardiovascular department of Muhimbili National Hospital with the chief complains of cough, chest pain, and difficulty in breathing, with the positive history of loss of weight. she is not diabetic nor hypertensive. She has been on treatment of SLE (Prednisolone and Methotrexate) for 4 years on admission the following investigation were done: chest x-ray, ECG, ,Echo, chest CT-scan, renal function, liver function and lipid profile, sputum for AFB,FBP
  • 2. A Case Report Of Suppurative …. 2 FIGURE 1: A CHEST X-RAY – showing abnormal cardiac silhouette-flask shaped appearance FIGURE 2: CHEST CT-ANGIOGRAPHY- showing pericardial effusion
  • 3. A Case Report Of Suppurative …. 3 FIGURE 4: ECG revealed non specific ST-changes and right atrial enlargement Echo revealed a swinging heart with a large pericardial effusion Renal function test, liver function test and lipid profile were normal. Pus culture – there was no growth Sputum for AFB- was negative FBP-showed leucocytopenia and anemia II. DISCUSSION: Purulent pericarditis is an infrequent, but important complication of infective illness, which if diagnosed early has a good prognosis. The incidence of the condition is probably increasing particularly in the immune-compromised group of patients. Classical symptoms and signs are often absent and a high index of awareness is required to diagnose the condition7 . Our patient presented with some symptoms cough, chest pain and difficulty in breathing but we had to have a high index of suspicion to diagnose it with atypical ECG presentation. Thus this case report is so significant because of how it presented and managed. Our patient underwent a surgical pericardial drainage of 700mls of pus, which was successful. Currently our patient is discharged, with vital signs stable, on the following medication: Tazact and metronidazole and breathing exercise (respiratory physiotherapy). REFERENCES: [1] www.turner-white.com (hospital physician)- Jan 2008, shiber pp.9-17,45 [2] Lange RA, hillis L.D. clinical practice. acute pericarditis in N Engl J Med 2005; 352:1163 [3] Goodman L.J. purulent pericarditis. Curr Treat options cardiovasc Med 2000; 2:343-50 [4] Spodick DH. The pericardium: a comprehensive text book. Newyork: M.bekker, 1997 [5] www.emedicine.medscape.com [6] www.ncbi.nlm.nih.gov [7] Annals of surgery (Ann surg. sep 1936; 104(3): 365-372 by James Harry Heyl [8] Textbook of Mayo clinic Internnal medicine [9] Rubin RH, moelling RC, Jr.Clinical microbiological and therapeutic aspects of purulent pericarditis. AM J med. 1975 Jul:59(1):68-78. (Pubmed)