SBP: Always peritonitis in decompensated cirrhosis? Case report and review of the literature

We report a case of a 56-year-old male with alcohol-associated liver cirrhosis presenting with septic and obstructive shock due to spontaneous bacterial peritonitis and pericarditis with tamponade. Imaging revealed ascites, pleural and pericardial effusion requiring drainage. Escherichia coli with identical resistance patterns was cultured from all drained fluids. Scintigraphy confirmed a peritoneal-pericardial connection. After initial treatment, fluid recurrences prompted evaluation for transjugular intrahepatic portosystemic shunt (TIPS) placement, which was unfortunately complicated by severe bleeding, ultimately leading to multi-organ failure and death. This case highlights the exceptional occurrence of pericardial effusion and spontaneous bacterial pericarditis as well as peritonitis as a complication of decompensated cirrhosis, with confirmed connection between the pericardium and the abdominal cavity by nuclear tracer study, as well as microbiological evidence. Based on an overview of all published cases management includes diuretics, paracentesis and in refractory cases, TIPS. Liver transplantation remains the definitive treatment.