Introduction: Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid.1 It was a rare but life-threatening condition.2 It may be primary or secondary to another infectious process. There are five pathogenic mechanisms that can lead to invasion of the pericardial space in secondary purulent pericarditis, there were contiguous spread from an intrathoracic site, hematogenous spread, extension from a myocardial site, perforating injury or surgery, and extension from a subdiaphragmatic site.1 The diagnosis can only be confirmed by pericardiocentesis.3 Treatment must include drainage of the pericardial space combined with systemic antibiotics.2 This case report focuses on a critical and rare clinical scenario of purulent massive pericardial effusion in an 85-year-old male patient. This condition, characterized by an infectious or inflammatory accumulation of fluid in the pericardial cavity, presents significant diagnostic and therapeutic challenges, particularly in the context of multiple comorbidities.
Case Description: The patient's presentation, complicated by pneumonia, diabetes mellitus (DM), and heart failure, underscores the complexities in diagnosing and managing elderly patients with diverse medical backgrounds. The diagnosis was compounded by his history of intermittent hypertension treatment and recent discovery of type II DM. His long-term smoking history and family medical history further influenced the clinical approach. The diagnosis of massive pericardial effusion was confirmed through echocardiography, which revealed the purulent nature of the effusion, a finding critical for guiding the management strategy. This led to a tailored treatment plan, incorporating both conventional and innovative therapies, and an urgent pericardiocentesis was performed, yielding significant clinical information and symptomatic relief.
Conclusion: The case highlights the importance of recognizing and promptly addressing purulent massive pericardial effusion in elderly patients with complex medical histories. The successful clinical outcome following the pericardiocentesis and the adaptive treatment approach provides valuable insights into the management of this severe condition. This report contributes to the body of medical literature by detailing a unique case of purulent massive pericardial effusion, underscoring the need for comprehensive and individualized patient care in similar clinical situations.