Cardiac tamponade likely due to candida infection, in an immunocompetent patient

Candida pericarditis presenting with cardiac tamponade and multiple organ failure after combined damage control thoracotomy and laparotomy with splenectomy in a trauma patient: Case report and review of literature

Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.

Purulent Pericarditis with Cardiac Tamponade Secondary to Candida Albicans after Total Parenteral Nutrition: A Case Report

Purulent pericarditis is characterized by a purulent pericardial fluid, which usually originates from the extension of a nearby bacterial infection site or by blood dissemination. Candida species is a rare cause of pericarditis; and if not treated, it is extremely fatal. In this report, we describe a 54-year-old man who had esophagojejunostomy due to gastric adenocancer 2 months before his admission into our emergency department with dyspnea, orthopnea, chest pain, and somnolence. Physical and echocardiographic examinations revealed massive fibrinous pericardial effusion, causing pericardial tamponade. We performed urgent pericardiocentesis. The culture of the purulent pericardial fluid illustrated Candida albicans. There was no gastropericardial fistula after endoscopic and computed tomographic evaluations of the gastrointestinal tract. After receiving 1 month of antimicrobial treatment, the patient recovered completely. During his follow-up, he remained asymptomatic and had no pericardial fluid for 6 months. Our case indicates the possibility of the occurrence of purulent pericarditis with tamponade, secondary to the dissemination of Candida albicans from total parenteral nutrition after gastric carcinoma surgery without gastropericardial fistulae or anastomosis leak.