Listeria monocytogenes pericardial effusion causing cardiac tamponade in a 47-year-old male was treated with pericardiocentesis draining 1200 mL, but the patient ultimately expired.
Case Report (n=1)
Listeria monocytogenes is a rare but highly fatal cause of pericardial effusion with tamponade in immunocompromised patients, requiring a high index of suspicion and prompt targeted therapy.
Abstract Background Listeria monocytogenes is a facultative intracellular, gram-positive bacillus that primarily effects immunocompromised and elderly individuals. Although invasive listeriosis typically manifests as bacteremia or central nervous system infection, cardiac involvement such as endocarditis, myocarditis, or pericarditis is exceedingly rare. Pericardial effusion with tamponade due to Listeria is particularly uncommon but carries a high risk of mortality if not promptly recognized. We present a unique case of Listeria monocytogenes infection manifesting as bacteremia, pericardial effusion with tamponade, and suspected meningitis in an immunocompromised adult. Case a 47-year-old Hispanic male with past medical history of alcoholic cirrhosis, esophageal varices, pulmonary arteriovenous malformation presented with acute respiratory distress. About two weeks earlier, he had been hospitalized with influenza A along with gastrointestinal bleeding. On arrival, he was tachycardic and hypotensive. Electrocardiogram showed sinus tachycardia with electrical alternans. Bedside ultrasound revealed a large pericardial effusion with tamponade physiology. Emergent pericardiocentesis was performed and drained 1200 mL of sanguineous fluid, leading to transient improvement in hemodynamics. Despite broad-spectrum antibiotics with Vancomycin and Piperacillin-Tazobactam, the patient developed refractory shock requiring multiple vasopressors, intubation, and continuous RRT. Laboratory evaluation revealed DIC with (INR 7.9, Fibrinogen 68 mg/dL0) for which he received several blood product transfusions. During hospital day two, both blood and pericardial fluid cultures grew Listeria monocytogenes. Antibiotic therapy was changed to Ampicillin and Gentamicin. Despite decreasing vasopressor requirements, the patient remained encephalopathic. Head CT demonstrated diffuse low-volume subarachnoid hemorrhage likely secondary to severe coagulopathy. Given his poor neurologic prognosis and multisystem organ failure, he was transitioned to comfort measures, and the patient expired. Conclusion Listeria monocytogenes infections are rare, with an incidence of approximately 0.24 cases per 100,000 the case fatality rate near 20%. Cardiac involvement, particularly pericarditis, is an uncommon manifestation seen primarily in immunocompromised hosts. Diagnosis requires microbiologic confirmation from pericardial fluid or blood cultures. Treatment typically involves high dose aminopenicillins and aminoglycosides for synergistic bactericidal effect. This rare presentation underscores the importance of maintaining a high index of suspicion for atypical presentations in high-risk populations. This abstract is funded by: none
Cate et al. (Fri,) conducted a case report in Listeria monocytogenes pericardial effusion with cardiac tamponade (n=1). Pericardiocentesis and antibiotics was evaluated. Listeria monocytogenes pericardial effusion causing cardiac tamponade in a 47-year-old male was treated with pericardiocentesis draining 1200 mL, but the patient ultimately expired.