Serratia marcescens-Induced Pericarditis Leading to Rapid-Onset Cardiac Tamponade in a Patient With Underlying Malignancy

Sep 29, 2026

Uploaded by dabgoudw

Serratia marcescens is a Gram-negative bacterium most often linked to urinary tract infections, respiratory infections, and catheter-related bloodstream infections, but it rarely causes pericarditis and tamponade, which is exceptionally uncommon. A case with intravenous drug use presented with dyspnea and chest pain. Imaging revealed moderate pericardial effusion with echocardiographic signs of imminent tamponade, later confirmed by pericardial fluid cultures. Treatment combined pericardial drainage and targeted antibiotics, emphasizing early recognition of unusual organisms in high-risk patients.

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CategoryHealthcare

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Review began 08/29/2025 Review ended 10/11/2025 Published 12/07/2025 © Copyright 2025 Acharya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98656 Open Access Case Report Serratia marcescens-Induced Pericarditis Leading to Rapid-Onset Cardiac Tamponade in a Patient With Underlying Malignancy Ashirbad Acharya 1 , Anurag Karki 1, Narayan Bhurtel 2 , Simran Pradhan 3, Puja Thapa 4, Yogesh Pandey 1, Suraj Shrestha 5, Ricardo Conti 1 1. Internal Medicine, AdventHealth Orlando, Orlando, USA 2. Internal Medicine, Kathamndu University School of Medical Scineces, Kathmandu, NPL 3. Department of Research and Development, National Open College, Lalitpur, NPL 4. Health Administration, University of Central Florida, Florida, USA 5. Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, NPL Corresponding author: Ashirbad Acharya, [ashirbad.acharya@gmail.com](ashirbad.acharya@gmail.com) Abstract Serratia marcescens is a Gram-negative bacterium that mostly causes urinary tract infections, respiratory infections, and catheter-related bloodstream infections. It rarely causes pericarditis, especially leading to tamponade, which is exceptionally rare. We describe a case that had a history of intravenous drug usage and presented with dyspnea and chest pain. Small cell lung carcinoma and a newly developed moderate pericardial effusion with echocardiographic indications of imminent tamponade were discovered during imaging. Pericardial fluid cultures identified Serratia marcescens. The patient was treated successfully with pericardial fluid drainage followed by antibiotics. This case emphasizes the importance of considering unusual organisms like S. marcescens when treating pericardial infections, particularly in patients who are at high risk. Early identification and focused treatment are crucial for the management of complications like cardiac tamponade. Categories: Cardiology, Internal Medicine, Infectious Disease Keywords: cardiac tamponade, iv drug-use, serratia, serratia marcescens pericarditis, small-cell lung carcinoma Introduction Serratia marcescens is a Gram-negative, facultative anaerobic bacterium that is an opportunistic pathogen causing various healthcare-associated infections [1], including urinary, respiratory, and catheter-related infections, especially in immunocompromised and intravenous drug users [2,3] . Cardiac involvement is rare; when it occurs, it most commonly presents as infective endocarditis, accounting for a small fraction of all endocarditis cases (e.g., Serratia caused 14% of all addict-associated endocarditis) [4] . Serratia pericarditis is exceptionally rare, with one reported case in 1983. [5] . We report a rare case of pericarditis caused by Serratia marcescens, leading to cardiac tamponade. This article was previously presented as a poster at the 2025 Society of Hospital Medicine Converge Meeting on April 24, 2025. Case Presentation A 66-year-old male with a history of intravenous (IV) drug use presented with a day history of acute onset chest pain and shortness of breath. The physical exam was unremarkable. Toxicology screen identified cocaine, cannabinoids, and fentanyl. X-ray showed a hilar mass, which on CT showed a right upper lobe nodule concerning for malignancy and mediastinal and hilar adenopathy. EKG showed diffuse non-specific ST-elevations. A urine culture revealed significant colonies of Klebsiella pneumoniae. The patient was started on trimethoprim-sulfamethoxazole. Bronchoscopic biopsy was subsequently performed, which showed small cell lung cancer and Actinomyces in lung culture. Initially absent on the first CT, follow-up CT 2 days later for staging revealed a previously undetected

FAQs

Why is Serratia marcescens pericarditis considered rare?

Serratia marcescens commonly causes urinary and respiratory infections and catheter-related bloodstream infections, but it rarely causes pericarditis. Cardiac tamponade as a complication is exceptionally uncommon.

What symptoms and key findings led to suspecting cardiac tamponade in the case?

The patient presented with acute chest pain and shortness of breath. Imaging and echocardiography showed a moderate pericardial effusion with signs such as mitral transvalvular velocity variation during respiration, consistent with tamponade physiology.

How was the patient managed after cultures confirmed the organism?

The patient underwent pericardial window drainage, and pericardial fluid cultures identified Serratia marcescens. Antibiotic therapy with piperacillin-tazobactam was given, and the patient later continued treatment to complete six weeks.

Sep 29, 2026

Uploaded by dabgoudw