Jornal de doenças infecciosas e terapia

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Primary Streptococcus pneumoniae Pericarditis with Cardiac Tamponade Diagnosed by Urinary Antigen Test of the Pericardial Fluid: Case Report and Literature Review

Marco Ridolfi, Lorenzo Volpicelli, Giancarlo Ceccarelli, Giammarco Raponi and Mario Venditti

Invasive pneumococcal disease is associated with high mortality and the incidence is higher in subjects with predisposing factors.
Purulent pericarditis is a rare localization of S. pneumoniae infection, mostly associated to a pulmonary source, whose prognosis is
poor due to the frequent complication of cardiac tamponade. Exceptionally, pneumococcal pericarditis could be primary. Early diagnosis
and treatment may result lifesaving, but unfortunately the cultures of pericardial fluid may prove falsely negative in patients undergoing
antibiotic treatment.
We report a unique case of Streptococcus pneumoniae pericarditis with no obvious focus of infection elsewhere at first, in a woman
with a rare genetic multisystemic disorder. Diagnosis was made with adoption of Streptococcus pneumoniae cell wall polysaccharide
fluorescent immunoassay (CWPS-FIA) urinary antigen test performed in the pericardial fluid and only later confirmed by standard culture.
Furthermore, we provide a literature review of this rare and serious condition.