Rapidly Progressive Immune-Mediated Meningococcal Pericarditis Presenting as Cardiac Tamponade

Christine Robert M Pagotan; Aryan Meknat; Anisha Ganesh; Neusha Hollingsworth; Masaki Tsukashita; M Scott Halbreiner; Candice Lee; Walter McGregor; Stephen Bailey

doi:10.1016/j.jaccas.2026.109105

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Rapidly Progressive Immune-Mediated Meningococcal Pericarditis Presenting as Cardiac Tamponade

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Rapidly Progressive Immune-Mediated Meningococcal Pericarditis Presenting as Cardiac Tamponade

Christine Robert M Pagotan, Aryan Meknat, Anisha Ganesh, Neusha Hollingsworth, Masaki Tsukashita, M Scott Halbreiner, Candice Lee, Walter McGregor and Stephen Bailey

JACC. Case reports, 109105

15 Jul 2026

DOI: https://doi.org/10.1016/j.jaccas.2026.109105

PMID: 42461175

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Abstract

pericardial effusion

immune complex disease

tamponade

inotropes

meningococcal infection

echocardiography

Pericardial involvement in meningococcemia is uncommon and often immune complex mediated. Initial effusions may appear insignificant but can rapidly progress to cardiac tamponade, even as systemic infection markers improve. A 65-year-old man presented with septic shock secondary to Neisseria meningitidis bacteremia. Initial imaging demonstrated a small pericardial effusion without clinical manifestations. Despite antibiotics and improving systemic markers, he developed sudden hemodynamic deterioration because of rapid effusion progression. Repeat echocardiography revealed tamponade physiology, necessitating emergent subxiphoid tube pericardiostomy. He was successfully stabilized through prompt intervention despite vasopressor dependence. This case illustrates a paradoxical clinical trajectory in immune complex-mediated meningococcal pericarditis, in which tamponade develops after bacteremic control. This dissociation between infectious and pericardial trajectories underscores the importance of serial imaging and proactive surgical planning independent of laboratory trends. In meningococcal infection, hemodynamic instability despite improving infection markers should prompt urgent echocardiographic reassessment. Early recognition and timely drainage may be lifesaving.

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Title: Rapidly Progressive Immune-Mediated Meningococcal Pericarditis Presenting as Cardiac Tamponade
Creators: Christine Robert M Pagotan - Drexel University
Aryan Meknat - Allegheny Health Network
Anisha Ganesh - Allegheny Health Network
Neusha Hollingsworth - Temple University
Masaki Tsukashita - Allegheny Health Network
M Scott Halbreiner - Allegheny Health Network
Candice Lee - Allegheny Health Network
Walter McGregor - Allegheny Health Network
Stephen Bailey - Allegheny Health Network
Publication Details: JACC. Case reports, 109105
Publisher: American College of Cardiology
Resource Type: Journal article
Language: English
Academic Unit: Cardiothoracic Surgery; Surgery
Other Identifier: 991022197221404721

Rapidly Progressive Immune-Mediated Meningococcal Pericarditis Presenting as Cardiac Tamponade

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