# Purulent Pericardial Abscess Caused by Escherichia coli in an Immunocompromised Patient Presenting With Mixed Septic and Cardiogenic Shock

## TL;DR

An immunocompromised patient developed a rare pericardial abscess caused by Escherichia coli, requiring urgent surgery and targeted treatment to survive.

## Contribution

This case report highlights the importance of early imaging and surgical intervention in managing purulent pericarditis in immunocompromised patients.

## Key findings

- A large pericardial abscess with air-fluid level was diagnosed in a 76-year-old woman with multiple myeloma.
- Escherichia coli was identified as the causative agent through cultures of pericardial fluid, blood, and urine.
- Targeted antimicrobial therapy and pericardiectomy improved the patient's condition after a complicated clinical course.

## Abstract

Purulent pericarditis and pericardial abscess are rare yet life-threatening complications of bacterial infection, particularly among immunocompromised individuals. We report the case of a 76-year-old woman with multiple myeloma undergoing chemotherapy who presented with lumbar pain, fever, hypotension, and acute kidney injury. Imaging revealed a large pericardial abscess with a distinct air-fluid level. Despite broad-spectrum antibiotics, fluid resuscitation, and high-dose vasopressor therapy, she progressed to mixed septic and cardiogenic shock. Urgent pericardiectomy drained purulent material that later cultured Escherichia coli, consistent with blood and urine culture results. Her clinical course was complicated by mediastinitis but improved with targeted antimicrobial therapy. She was discharged after 38 days. This case highlights the diagnostic challenges and the critical role of early imaging and prompt surgical intervention in purulent pericarditis, especially in immunocompromised hosts.