Unique Case of Haemophilus Influenzae Purulent Pericarditis Secondary to Infected Mirena Coil

Evangelos Tzolos, Mohammed Anwar and Anne Scott

Department of Cardiology, Royal Infirmary Edinburgh, UK

^*Correspondance to: Evangelos Tzolos 

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Abstract:

A 50 year old previously fit and well lady presented with septic shock. The chest x-ray suggested cardiomegaly and bilateral pleural effusions both of which were new compared to 2 years ago. Inflammatory markers were raised. Sepsis 6 protocols were followed including treatment with broad spectrum antibiotics. A CTPA was performed and showed bilateral pleural effusions and a moderate global pericardial effusion. Bedside echocardiography the next morning confirmed a moderate global pericardial effusion. No clear echocardiographic features of tamponade were present and no pulsus paradoxus elicited but in view of her resistant hypotension requiring inotropes despite adequate filling a decision was made to perform urgent pericardiocentesis. An urgent pericardiocentesis was performed and an immediate improvement in blood pressure was observed. The pericardial fluid had an unusual creamy color and slightly viscous consistency. Pericardial fluid cultures later confirmed the presence of Haemophilus Influenzae. A Mirena coil was inserted one month prior to admission. A high vaginal swab from the intrauterine mirena coil revealed H. Influenzae infection and prompted removal of the device and full recovery of the patient. We have reviewed PubMed and found 10 cases of H. Influenzae pericardial effusion and tamponade in adults. This appears to be the first reported case where the primary focus of Haemophilus Influenzae appears to have been related to an intrauterine device. It also illustrates the importance of considering tamponade where classical physical and echocardiographic signs are not present.

Keywords:

Haemophilus influenzae; Pericarditis

Cite the Article:

Tzolos E, Anwar M, Scott A. Unique Case of Haemophilus Influenzae Purulent Pericarditis Secondary to Infected Mirena Coil. Clin Case Rep Int. 2018; 2: 1056.