Pericardial effusion with a ruptured mycotic pseudoaneurysm secondary to Salmonella infection

A 59-year-old Iban man with an underlying hypertension and a history of pulmonary tuberculosis experienced an on-off chest pain and reduced effort tolerance for 1 month. He presented to the hospital due to a worsening chest pain.

On physical examination, the patient was afebrile. Result of the cardiovascular examination was unremarkable. Consolidation or effusion was not observed on chest radiography. Electrocardiography showed diffuse ST elevation; hence, fibrinolytic therapy was administered (Figure 1). Electrocardiography showed persistent ST elevation without dynamic ischemic changes. The patient’s C-reactive peptide level was high (408.8 mg/L).

FIGURE 1:
Electrocardiogram showing diffuse ST elevation.

The ST elevation myocardial infarction had reverted to pericarditis. Nonsteroidal anti-inflammatory drug therapy was started but was later switched to high-dose aspirin due to acute kidney injury. Echocardiography revealed pericardial effusion with signs of tamponade (Figure 2). Pericardiocentesis was performed, and the pericardial fluid culture showed Salmonella enteritidis. Intravenous ceftriaxone was administered.

FIGURE 2:
Echocardiography showing pericardial effusion and tamponade signs.

The patient’s condition deteriorated.

Patient’s computed tomography angiogram showed a ruptured aortic arch saccular aneurysm measuring 1.7×3×4.1 cm, surrounded by a rim of mediastinal hematoma 5.7×6.6×5.3 cm that extended into the left main bronchus (Figure 3).

FIGURE 3:
Computed tomography angiogram showing a ruptured aortic arch saccular aneurysm (arrow).

The patient was frail to undergo surgical intervention and eventually died.

Mycotic pseudoaneurysms and massive pericardial effusion due to Salmonella infection rarely occur¹. However, complications are often fatal. Hence, early diagnosis and intervention are crucial to reduce mortality¹.

ACKNOWLEDGMENTS

We would like to thank the Director General of Health Malaysia for his permission to publish this article. We express our greatest gratitude to Hospital Miri staff who took good care of the patient.

REFERENCES

• ¹
  Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864.

• Financial Support: We did not receive any financial support.

Publication Dates

• Publication in this collection
  29 Apr 2022
• Date of issue
  2022

History

• Received
  11 Feb 2022
• Accepted
  09 Mar 2022