A Rare Case of Pericardial Salmonellosis in a Patient with Aneurysmatic Left Ventricle

Abstract

Cardiovascular manifestations of salmonellosis such as endocarditis, infected atheroma or aneurysms, myocarditis and pericarditisare uncommon, which can occur only in about 5% of bacteremia.Although the pericardium is rarely involved, the mortality rate is as high as 50%. We reported a case a rare case of pericardial salmonellosis in patient with aneurysmatic left ventricle. A62-year-old male patient presents to the emergency department with presentation of shortness of breath, febrile, diarrhea, chest pain and abdominal pain. He was known had history of ischemic heart disease, heart failure, and left ventricular aneurysm. On examination, patient was febrile, had tachycardia and tachypnoea. Physical examination revealed febrile 39^oC, pulmonary rales, tenderness in right superior abdomen region. After threedays of therapy there was no improve. During hospitalization he complained of heaving shortness of breath, vital sign was being unstable, rhonchi and wheezing almost filled his lung, elevation jugular vein pressure, and no diminished heart sound. Treatment of diuretic had been administered but tightness does not improve. The patient then underwent echocardiography. Echocardiography revealed a massive pericardial effusion with sign of impeding tamponade (RA RV collapse). An urgent pericardiocentesis was performed with the first aspirations obtained 475 cc. Pericardial fluid culture result Salmonellasp., antibiotic was administered based on the culture results, intravenous ceftazidime one gram twice daily and levofloxacin 750 mg once daily. After 5 days, patient’s condition was improved. Unfortunately, patient suddenly suffered by convulsion and electrocardiographyshowedventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The patient died caused due to malignant arrhythmia.This case illustrates that the important role of echocardiography in establishing the diagnosis of massive pericardia effusion in previously untreated patients with pericardial effusion with clinical presentation acute lung oedema. Echocardiography plays an important role in detecting rare complications of salmonellosis. An understanding of the potential cardiovascular complications cause by Salmonella infection is critical for both diagnose and management.