{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T14:35:08Z","timestamp":1788273308007,"version":"build-2803163510"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,1,29]]},"abstract":"<jats:p>We report a case of a frail 82-year-old man with seronegative rheumatoid arthritis and a recent pacemaker insertion, admitted with pulmonary oedema and a symptomatic pericardial effusion. He was treated with diuretics and an urgent pericardiocentesis, a sample from which cultured <jats:italic>Enterobacter cloacae<\/jats:italic>. A subsequent abdominal CT scan revealed faecal loading, an abnormal anorectal canal and sigmoid colon and a bowel perforation. Endoscopy, biopsies and histopathology confirmed a diagnosis of cytomegalovirus (CMV) colitis with coexistent fungal infection. The <jats:italic>E. cloacae<\/jats:italic> infection was successfully treated with 6\u2005weeks of intravenous meropenem, while the CMV and fungal infections were treated with a combination of valganciclovir and fluconazole. We postulate that the bowel perforation resulted from a combination of CMV colitis, faecal loading and steroid therapy and led to bacterial translocation of <jats:italic>E. cloacae<\/jats:italic> and the development of the pericardial effusion. This case represents an unusual pathophysiology for the development of an <jats:italic>E. cloacae<\/jats:italic> pericardial effusion.<\/jats:p>","DOI":"10.1136\/bcr-2014-207025","type":"journal-article","created":{"date-parts":[[2015,2,20]],"date-time":"2015-02-20T10:53:20Z","timestamp":1424429600000},"page":"bcr2014207025","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["<i>Enterobacter cloacae<\/i> pericardial effusion in a frail elderly patient"],"prefix":"10.1136","volume":"2015","author":[{"given":"H J","family":"Blundell","sequence":"first","affiliation":[{"name":"Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C A","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,2,19]]},"reference":[{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.1","unstructured":"Mims C , Dockrell H , Goering RV , et al . 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Vital Signs: Carbapenem resistant Enterobacteriaceae, Morbidity and Mortality Weekly Report. http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6209a3.htm (accessed 2 Jul 2014)."},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.7","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1128\/IAI.66.2.645-649.1998","article-title":"Occurrence of virulence-associated properties in Enterobacter cloacae","volume":"66","author":"Keller","year":"1998","journal-title":"Infect Immun"},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.94.07091716"},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs372"},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.10","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(04)01108-9"},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.11","doi-asserted-by":"publisher","DOI":"10.1007\/BF02017607"},{"key":"2025082701414378000_2015.feb19_1.bcr2014207025.12","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-012-0376-9"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-207025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:41:53Z","timestamp":1756284113000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-207025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,19]]},"references-count":12,"alternative-id":["10.1136\/bcr-2014-207025"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-207025","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,19]]}}}