Acute pericarditis caused by Kocuria kristinae with successful withdrawal from hemodialysis: a case report.
Kyoji Chiba, Takumi Osugi, Kazuki Amabe et al.
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Case in brief
A 47-year-old man developed dialysis-dependent acute kidney injury after severe heatstroke. About a month later, imaging showed a marked increase in cardiothoracic ratio, and echocardiography demonstrated a substantial pericardial effusion. Anti-inflammatory treatment did not reduce the effusion. Ultrasound-guided pericardiocentesis drained 1050 mL of pale-yellow, neutrophil-predominant exudate; Kocuria kristinae was identified using the VITEK 2 system. After drainage and susceptibility-guided vancomycin, the effusion and venous congestion decreased and urine output increased. The interventions may have contributed to renal recovery, and hemodialysis was discontinued on day 102.
What made this case unusual
K. kristinae, a commensal skin bacterium and potential contaminant, was isolated from pericardial fluid in a clinically compatible case of massive inflammatory effusion.
Diagnostic / clinical pearl
Interpret K. kristinae in pericardial fluid cautiously: it may be a contaminant, but the clinical setting should inform that assessment.
Why it matters
In this case, massive effusion with venous congestion accompanied delayed renal recovery; drainage was followed by increased urine output and eventual withdrawal from hemodialysis.