Purulent
pericarditis (PP) is a very serious condition with almost 100% mortality if untreated. Intrapericardial fibrinolysis is a preferred alternative to
pericardectomy in the treatment of persistent PP, but there are no consensus guidelines on the standard protocol for this procedure in children. A 9-year-old boy was referred to the Medical Research Council Unit in The Gambia (MRC). He had been unwell for 18 days with a high continuous
fever,
cough, fast breathing, and dyspnoea on exertion. Prior to referral he had been treated for
malaria and
pneumonia with no improvement. At the MRC, he was diagnosed with purulent
pericarditis caused by Staphylococcus aureus and after admission he was managed for 4 weeks with intravenous
antibiotics, pericardial aspirations followed by saline lavage of the pericardium and intrapericardial
antibiotic instillation. Despite these measures, massive re-accumulation of the purulent
pericardial effusion continued. Once daily intrapericardial instillation of
streptokinase at a dose of 18,000 i.u/kg diluted in 50 ml of
normal saline, and saline washout of the pericardium after 2 hours was commenced on the 29th day of admission, in addition to the
antibiotics. This technique of fibrinolysis employed for 2 days was effective in managing the persistent purulent
pericarditis when pericardial aspiration and intravenous and intrapericardial
antibiotics failed.