Difficult to treat purulent pericarditis - where does full sternotomy stand? A case report.

Introduction: Purulent pericarditis is a subtype of acute pericarditis with a high mortality even when adequately treated. Standard therapy is a combination of antibiotics and drainage, which can be more or less invasive. This is a case report of a patient with purulent pericarditis where cardiac surgery via sternotomy for thorough debridement and lavage was required for complete infection control. Case presentation: A 41-year-old man with a history of injected and inhaled drug use was admitted with a large pericardial effusion, and 700 mL of pus was percutaneously drained. After being started on broad spectrum antibiotics the patient remained with persistent signs of infection, and was submitted to surgical drainage and debridement via full median sternotomy. The patient improved progressively afterwards, and after agent identification and being started on intravenous penicillin, he was discharged after 4 weeks, without evidence of wound infection. Clinical Discussion: An organized pleural effusion was likely the cause of the purulent pericarditis. Of all invasive treatment options available, full median sternotomy was considered the most appropriate for this patient, as it allowed for maximal exposure for debridement. Even though the patient was operated in an actively infected state, there was no wound infection or dehiscence, in part because of meticulous perioperative wound care. Conclusion: Purulent pericarditis is a fatal disease, and cardiac surgery via full median sternotomy may be necessary and at times the most appropriate for adequate complete treatment, as it is simple, easily reproducible, and with an acceptable risk of wound infection.