Infectious and Noninfectious Acute Pericarditis in Children: An 11-Year Experience

Table 2

Clinical characteristics of 11 children with acute pericarditis due to infectious causes.

Age	Presentation	Associated condition	Relevant labs	Imaging	Etiology		Outcome
16yr M	Retrosternal chest pain	SLE and hypertension receiving prednisone 30mg BID. Left hand abscess	Blood culture: MSSA. Left hand abscess: MSSA	Chest CT: Pericarditis with effusion. Bilateral pleural thickening	MSSA	Pericardiocentesis with pericardial drain; IV oxacillin x 3 weeks plus; Oral rifampin x 2 weeks	Improved
16 mo F	Fever, septic shock, right index finger abscess, tachycardia, respiratory distress	Abscess right index finger	Finger abscess, blood culture: MSSA; Pericardial fluid and tissue cultures: MSSA	Chest CT: Pericardial and pleura effusions Echocardiogram: day 1: small pericardial effusion, day 3: large effusion, atrial collapse with systole, tamponade, fibrous strands.; Pericardial biopsy: fibrinous pericarditis	MSSA	Pericardiocentesis with drain on day 3: 90 ml of serous fluid drained followed 4 days later by pericardial window with mediastinal exploration and chest tube placement due to fibrosis; IV oxacillin x 3 weeks; IV cefazolin x 3 weeks	Improved but developed severe hypertension of unclear etiology
6 yr F	Fever, dizziness, right leg swelling, tenderness and induration, respiratory distress, signs of septic shock	Salter-Harris fracture type I right tibia. Osteomyelitis with subperiostal abscess of the right distal tibia	Cultures: blood, wound, urine, pericardial: MRSA. Normal immune work up including oxidative burst assay	Chest CT: multiple nodular cavitary lesions suggestive of septic emboli, left lower lobe pneumonia with effusion, large pericardial effusion	CA-MRSA	Pericardiocentesis, left chest tube placement; IV vancomycin and clindamycin x 2 weeks; IV clindamycin x 4 weeks	Improved but developed hypertension of unclear etiology
2 yr F	Fever, oral ulcers: herpangina, dyspnea, cough, tachycardia, poor oral intake	Eczema. Multifocal pneumonia with empyema. Right retroperitoneal and psoas abscess	Cultures: blood, pleura fluid, psoas abscess: MRSA. Pericardial biopsy: organizing fibrinous pericarditis	Chest CT: Multifocal pneumona, empyema at right medial pleural space adjacent to heart, pericardial effusion	CA-MRSA	Pericardiocentesis. Incision and drainage of pleural empyema.; IV clindamycin and IV vancomycin x 19 days then IV clindamycin to complete 6 weeks	Improved
3 yr F	Fever, respiratory distress, decreased activity	Left lower lobe pneumonia, empyema	Blood, pleural and pericardial fluid cultures: negative Received antibiotics prior to cultures.	Chest CT: left lower lobe pneumonia, large left pleural effusion, pericardial effusion	Culture negative purulent pericarditis	Mediastinal exploration. Pericardiotomy and drainage of pericardial and pleural empyema; IV ceftriaxone and vancomycin x 6 weeks	Improved
15y M	Fever, chest pain & pressure. Pericardial rub, tender RUQ	None	Histoplasma M band positive	Chest CT: left upper lobe infiltrate, left hilar adenopathy, pericardial, left pleural effusion	Histoplasma capsulatum	Itraconazole x 2 months; Ibuprofen	Improved
14 yr M	Right shoulder pain, cough	ALL last chemotherapy 8mo earlier	Histoplasma M band positive. CF yeast titer 1:32 (NL 1:8)	Chest CT: patchy left upper lobe infiltrate, mediastinal adenopathy, necrotic left mediastinal LN	Histoplasma capsulatum	Itraconazole x 6 months	Improved; Follow up CT chest: resolution of adenopathy, small calcified left upper lobe lesion
2 yr F	Fever, dyspnea	None	Pleural fluid bacterial and viral cultures are negative. Mycoplasma IgM positive	Chest X-ray: cardiolmegaly due to pericardial effusion. Obscured left hemidiaphragm due to possible pneumonia	Mycoplsma pneumoniae	Pericardiocentesis: 360 ml of bloody fluid; IV ceftriaxone x 4 days; Oral azithromycin x 10 days	Improved
9 yr F	2 hospitalizations: Fever, cough, dyspnea, chest pain, abdominal pain, tachycardia, left lung rales	Left lower lobe pneumonia	Pericardial fluid bacterial, viral, mycobacterial cultures negative. Fluid Enterovirus PCR and Adenovirus PCR are negative. Mycoplasma Ig M positive	Chest CT scan (second hospitalization): pericardial effusion, pericardial thickening, small bilateral pleural effusion, left lower lobe pneumonia	Mycoplsma pneumoniae	Pericardiocentesis during first admission; First hospitalization: IV ampicillin followed by IV vancomycin total 5 days, discharge to continue with amoxicillin.; Second hospitalization: azithromycin and steroids	Readmitted for recurrence 5 days after initial discharge; Improved after second hospitalization
7 yr M	Fever, abdominal pain, sore throat, vomiting, diarrhea, skin rash, tachypnea, hepatomegaly	None	Viral culture: rectum, throat, pericardial fluid: Enterovirus. Pleural fluid Enterovirus PCR positive	Chest CT: pericardial effusion, small right pleural effusion, no mediastinal adenopathy or lung lesions	Enterovirus	Pericardiocentesis	Improved; Repeat echocardiogram after drainage showed resolution of effusion
6 yr F	Fever, cough, runny nose, dyspnea, wheezing, tachycardia	Down Syndrome, bicuspid aortic valve, asthma, hypothyroidism,	Influenza PCR +ve 2009 H1N1. Bacterial cultures negative	Echocardiogram: right atrial collapse, pre-tamponade	Influenza A	Pericardiocentesis; Oseltamivir, perdnisolne	Improved; Repeat echocardiogram after drainage showed resolution of effusion

patients had drainage via pericardiocentesis for moderate or large pleural effusions.
M: male. F: female. CT: computed tomography. ALL: acute lymphoblastic leukemia. MSSA: methicillin susceptible Staphylococcus aureus. CA-MRSA: community-acquired methicillin resistant Staphylococcus aureus. SLE: systemic lupus erythematosus.