The clinical findings in five patients with purulent pneumococcal pericarditis are presented. Predisposing factors were untreated pneumococcal pneumonia and empyema in three patients and congenital hypogammaglobulinemia in one patient. The three patients, in whom the diagnosis was established by pericardiocentesis, recovered without sequelae after surgical drainage of the pericardium and systemic antibiotic therapy. The two remaining patients had unsuspected purulent pericarditis demonstrated postmortem. A review of 113 cases of purulent pneumococcal pericarditis since 1900 was made. A preceding pneumonia was present in 93.1 per cent of the patients; 66.6 per cent had pneumonia with empyema. Signs frequently associated with pericarditis such as a pericardial friction rub, pulsus paradoxus and an enlarged cardiac silhouette may be absent although circulatory embarrassment exists. Pericardiocentesis is mandatory to establish the diagnosis of purulent pneumococcal pericarditis. Although mortality in untreated patients was 100 per cent, the 10 patients treated with both systemic antibiotics and surgical drainage survived.
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