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August 16, 1985

Purulent Pericarditis and Mediastinitis due to Peptococcus magnus

Author Affiliations

From the Division of Infectious Disease, Department of Medicine, University of California at San Francisco.

JAMA. 1985;254(7):947-948. doi:10.1001/jama.1985.03360070085029

PURULENT pericarditis and atraumatic mediastinitis are both uncommon illnesses. We report herein a case with both infections due to Peptococcus magnus, a pathogen reported only rarely1,2 as the cause of either infection. The source of infection was probably an occult tooth abscess.

Report of a Case  A 30-year-old man was admitted elsewhere after two weeks of progressive fever, pleuritic chest pain, cough, and dyspnea. Examination disclosed fever and findings of pericardial tamponade. A chest roentgenogram showed cardiomegaly, and an echocardiogram showed normal valves and a large pericardial effusion. Pericardiocentesis was performed, with removal of 10 mL of purulent fluid. Examination of the fluid revealed 67,000 white blood cells (89% polymorphonuclear leukocytes) and gram-positive cocci. Blood cultures were not obtained. Therapy with nafcillin sodium and tobramycin was begun, and clindamycin was added when only anaerobic cultures yielded organisms. Biochemical identification of the pathogen as P magnus and persistent fever prompted