P0454 - Bacterial Pericarditis Secondary to Group A Streptococcus

Acute bacterial pericarditis is a rare yet serious condition. Bacterial pericarditis secondary to Group A Streptococcus is an uncommon cause of bacterial pericarditis but has been associated with the development of tamponade, a life-threatening complication which requires prompt attention.

The patient was a 2-year-old, 14.5 kg previously healthy male who presented with prolonged fever, fussiness, decreased oral intake. He was initially admitted and treated for dehydration. Due to progressive ill-appearance and persistent fever, a CT was obtained to assess for retropharyngeal abscess. The CT showed questionable tortuous internal jugular veins; in conjunction with tachycardia, a cardiac workup was obtained due to concerns of impeded venous drainage. Echocardiogram showed a moderate, circumferential pericardial effusion with RV diastolic collapse, consistent with tamponade physiology. EKG was consistent with acute pericarditis. Causative etiologies explored included rheumatologic, infectious and oncologic pathologies. A pericardiocentesis was performed, initially draining 150 milliliters of fluid. Pericardial fluid showed a moderate burden of white blood cells and gram positive cocci. PCR of fluid, although not standardly performed, demonstrated Group A Streptococcus. Throat culture for Group A Streptococcus was also positive, as was serum antistreptolysin O titers. He was treated with a course of ceftriaxone. The remainder of his workup was unremarkable.

After drainage and antibiotic therapy, he improved and was discharged home on hospital day 15. He has subsequently remained stable 29 days from discharge at his follow up.

The nonspecific symptoms of acute bacterial pericarditis make it a diagnostic challenge. Prompt identification and management of pericarditis and pericardial effusion may avoid long term morbidity and mortality. We postulate that this case of bacterial pericarditis was secondary to Group A Strep pharyngitis, a phenomenon rarely described in the literature.