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A6452 - Acute Bacterial Pericarditis: A Rare Complication of Transbronchial Biopsy
Author Block: J. Rathod1, V. R. Patel2; 1Internal Medicine, Aurora Health Care, Milwaukee, WI, United States, 2Aurora Health Care, Milwaukee, WI, United States.
Introduction: We present a patient who underwent endobronchial ultrasound-guided transbronchial biopsy for mediastinal mass who later developed a rare complication from this procedure. Case Report: A 41 year old Pakistani man with past medical history of hypertension presented to his primary physician complaining of right sided chest wall pain. He was then referred to pulmonary clinic after undergoing chest CT which showed considerable mediastinal lymphadenopathy. He did not have any respiratory symptoms at that time, and labs were ordered including Quantiferon gold, HIV, and ACE level. These were negative except for ACE level which was elevated at 132. The patient subsequently underwent transbronchial biopsy, with pathology report showing non-caseating granulomas. The patient was diagnosed with stage I sarcoidosis and kept without treatment due to being fully asymptomatic. Three months following bronchoscopy, the patient was hospitalized due to acute epigastric pain. EKG showed diffuse ST segment elevation, and echocardiogram showed pericardial effusion with non-hemodynamic significance. The patient remained stable and was discharged with colchicine and ibuprofen. Five days later, the patient was admitted again for similar complaints. During the admission, he became hypotensive and was found to have cardiac tamponade requiring emergent pericardial window. Pericardial fluid grew Methicillin sensitive Staphyloccous aureus and Prevotella species indicating acute bacterial pericarditis. Discussion: This 41 year old man, with no history of intravenous drug abuse and limited PMH, was diagnosed with acute bacterial pericarditis secondary to MSSA and Prevotella species. Given the lack of IV drug abuse, and no other suspected etiologies, it was determined that bacterial seeding of the pericardial fluid likely occurred during his transbronchial biopsy several months prior to the development of symptoms. The pericardial effusion likely worsened over time due to the lack of antibiotic treatment, which was ultimately evidenced by the patient’s clinical deterioration due to cardiac tamponade. Literature review on the complications of transbronchial biopsy showed multiple cases of pneumopericardium; however, findings were limited when searching for bacterial pericarditis occurring secondary to transbronchial biopsy. This case highlights an extremely rare complication of transbronchial biopsy.