Abstract 14850: Streptococcus Constellatus: A Rare Cause of Cardiac Tamponade and Constrictive Pericarditis

Introduction: Cardiac tamponade is an emergency medical condition referring to the buildup of fluid in the pericardial sac, which can compress the heart and lead to hemodynamic instability. Streptococcus constellatus, a member of the Streptococcus viridans group, has been implicated as a rare cause of cardiac tamponade with only 3 cases reported in the medical literature. We present a unique case of Streptococcus constellatus (S. constellatus) induced purulent pericarditis leading to cardiac tamponade and constrictive pericarditis.

Case presentation: A 56-year-old female with no significant past medical history presented with intermittent fever, non-productive cough, and worsening shortness of breath for 2 weeks. She initially went to Convenient Care a week ago for a sore throat with a low-grade fever and was sent home with oral antibiotics. Initial vitals revealed hypotension, high-grade fever, and tachycardia. Physical examination was remarkable for elevated jugular venous pressure and muffled heart sounds. Lab work showed significant leukocytosis. EKG was remarkable for diffuse ST-elevation, low QRS voltage, and electrical alterans. A transthoracic echocardiogram (TTE) revealed severe pericardial effusion. Emergent pericardiocentesis was performed draining 370 ml of purulent fluid and post-operative TTE revealed trace pericardial effusion. Blood and pericardial fluid cultures came back positive for S. constellatus. Another trans-esophageal echocardiogram (TEE) was performed during the hospital stay that was negative for any vegetation however, revealed thickened pericardium with septal bounce suggesting constrictive pericarditis. Cardiothoracic surgery recommended repeat TTE in 3 months for possible pericardiectomy if pericardial changes persist. The patient was discharged on oral antibiotics and colchicine in stable condition.

Discussion: S. constellatus is typically part of oral, respiratory, and gastrointestinal flora. It can reach the pericardial space through hematogenous spread or direct extension from nearby infections. Our case highlights prompt identification and appropriate treatment which are crucial for managing this potentially life-threatening and unique condition.