Case report: Group B streptoccocus related lower limb necrotizing fasciitis, complicated by purulent pericarditis and cardiac tamponade

• Published in: British Journal of Medical Practitioners
• Main Author: Shariff R.E.F.R.; Khir R.N.; Kasim S.
• Format: Article
• Language: English
• Published: JMN Medical Education Ltd 2019
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070196542&partnerID=40&md5=154ebfb673a35d3adb4f0bf85075444c

Background: Necrotizing soft tissue infections (NSTI) are severe and rapidly progressive. Rarely, Group B Streptococcus (GBS) can cause NSTI, majority due to an immunocompromised state. Even more uncommon is pericardial involvement following NSTI of a non-adjacent structure. Case Report: We report a challenging case of NSTI of the lower limbs due to GBS, with acute pericardial dissemination leading to cardiac tamponade. Bedside echocardiography revealed a massive pericardial effusion, measuring largest at 2 cm in depth, with evidence of both right atrial and ventricular collapse, leading to an urgent pericardiocentesis being performed which revealed turbid-looking aspirate. Urgent gram staining revealed moderate amounts of pus cells with occasional gram positive cocci. Wound debridement was performed on day 3 of admission, and tissue cultures were taken peri-operatively. Cultures from blood, pericardial aspirate and tissue aspirate were positive for Streptococcus Agalactiae. Unfortunately, the patient deteriorated post-operatively due to extensive blood loss and overwhelming septicaemia and succumbed to his illness 72 hours after. Conclusions: This case highlights the rare possibility of cardiac involvement in cases of NSTI, and the possibility of cardiac tamponade causing cardiogenic shock masquerading alongside septic shock, and reminds clinicians on the importance of combining clinical acumen and appropriate ancillary testing to facilitate early detection of a fatal condition. © 2019, JMN Medical Education Ltd. All rights reserved.