Massive Haemopericardium in a Case of Aortic Infective Endocarditis

The prototypic lesion of Infective Endocarditis (IE), known as vegetation, is a mass of platelets, fibrin, microorganisms and scant inflammatory cells. IE can involve heart valves, low-pressure areas of an intracardiac defect, mural endocardium damaged by aberrant jets of blood or foreign bodies, or intracardiac devices. A similar process involving arteriovenous shunts, a patent ductus arteriosus, or a coarctation of the aorta is called infective endarteritis. Hereby, the authors present a case of 50-year-old female, known case of chronic kidney disease, presented to the Emergency Department with a history of fever, dry cough and chest pain for 10 days, along with acute onset breathlessness. Upon urgent clinical examination and investigation, she was found to have a massive haemopericardium causing cardiac tamponade and vegetation on the aortic valve cusp. Pericardiocentesis was performed immediately on an emergency basis and one liter of blood was drained from the pericardial sac. The pericardial fluid and blood were sent for culture to further evaluate the suspected IE. Enterococcus raffinosus was isolated from three blood culture sets sent half an hour apart. Appropriate antibiotics were initiated and the patient was discharged after two weeks of intravenous antibiotics. The enterococcus species is a known pathogen that can cause IE, but Enterococcus raffinosus is not a common organism found in endocarditis. It has previously been implicated as a colonic pathogen. The present case highlights the swift detection and diagnosis of a rare organism responsible for causing IE.