Clostridial pericarditis diagnosed antemortem.

Abstract This report describes a case of spontaneous gas gangrene of the pericardium in a patient who survived 4 months. The diagnosis was established antemortem, and the patient was treated with broad-spectrum antibiotics, injected intramuscularly, penicillin, given parenterally and by local instillation, and surgical drainage. He rapidly developed constrictive pericarditis and died, probably from septic embolism to the spleen, with subsequent peritonitis and toxic shock, before pericardictomy could be performed. It is postulated that the process arose as a primary infection in a mural thrombus or in an area of ischemic myocardium after clostridial bacteremia.