Acute pericarditis caused by Kocuria kristinae with successful withdrawal from hemodialysis: a case report.

A 47-year-old man with severe heatstroke and dialysis-dependent AKI developed massive pericardial effusion about one month after starting hemodialysis.

• The patient developed severe heatstroke, followed by AKI that required hemodialysis.
• Approximately 1 month later, the cardiothoracic ratio increased markedly.
• Echocardiography revealed substantial pericardial effusion.

Anti-inflammatory therapy did not improve the pericardial effusion.

• Treatment comprised non-steroidal anti-inflammatory drugs, colchicine, and prednisolone.
• The abstract describes a poor response, with no improvement in the effusion.

Ultrasound-guided pericardiocentesis drained 1050 mL of pale-yellow, exudative, neutrophil-predominant fluid.

• The fluid was exudative with neutrophil predominance, consistent with an inflammatory/infectious process.
• Drainage was performed under ultrasound guidance.

Kocuria kristinae was identified from the pericardial fluid using the VITEK 2 system, and vancomycin was dosed according to susceptibility results.

• K. kristinae is a commensal skin bacterium that occasionally acts as an opportunistic pathogen.
• It is rarely associated with pericardial infection.

After drainage and antimicrobial therapy, pericardial effusion decreased, venous congestion was alleviated, and urine output increased, with hemodialysis discontinued on day 102.

• The authors state these interventions may have contributed to renal recovery and hemodialysis discontinuation.
• This is a single-patient case report, so causality cannot be established.

The authors conclude that massive pericardial effusion with venous congestion can delay renal recovery in severe AKI, while pericardial drainage facilitates urine output recovery and withdrawal from hemodialysis.

• Recovery of urine output followed relief of venous congestion by drainage.
• This is presented as a suggestion from a single case.

The authors advise that K. kristinae isolated from pericardial fluid should be regarded as a possible contaminant despite a clinically compatible setting.

• K. kristinae is a skin commensal, so isolation alone may not prove infection.
• The caution applies even when the clinical context is compatible with infection.