A Case of Constrictive Pericarditis Due to Disseminated MSSA Infection: A Rare Cause of Anasarca

Abstract

Background: Constrictive pericarditis is an uncommon cause of systemic venous congestion and may present with generalized edema due to impaired ventricular filling.  In the modern antibiotic era, bacterial pericarditis has become rare, and progression to constrictive physiology is infrequently encountered.  Staphylococcus aureus–associated constrictive pericarditis is particularly uncommon and usually occurs in the setting of disseminated infection.  Its insidious presentation often delays diagnosis, contributing to significant morbidity if not recognized early. Case Report: We report a 40-year-old diabetic male presenting with progressive generalized edema, dyspnea, ascites, and intermittent fever.  He had a history of recurrent subcutaneous abscesses with prior cultures growing methicillin-sensitive Staphylococcus aureus (MSSA).  Vitals were stable at the time of admission. Clinical examination revealed anasarca, elevated jugular venous pressure, ascites, and a tender anterior chest wall swelling.  Investigations demonstrated high serum–ascites albumin gradient, high-protein ascites, and transudative pleural effusion, suggesting a cardiac etiology.  Echocardiography and cardiac magnetic resonance imaging (MRI) revealed diffuse pericardial thickening with classical features of constrictive physiology.  Blood and pus cultures confirmed disseminated MSSA infection. The patient improved with culture-directed antimicrobial therapy and subsequently underwent pericardiectomy, with significant clinical recovery Conclusion: This case illustrates a rare presentation of constrictive pericarditis secondary to disseminated MSSA infection in a patient with diabetes mellitus. It highlights the importance of recognizing infectious causes of constrictive pericarditis in patients presenting with unexplained anasarca and recurrent staphylococcal infections, as early diagnosis and timely intervention can significantly improve outcomes.