Bacterial pericarditis in a child with asthma

A six-year old girl with atopic asthma developed middle lobe pneumonia and contiguous purulent pericarditis while on therapy with cromolyn sodium dry powder. A strain of Streptococcus viridans resistant to penicillin was isolated from the pericardium and tracheal aspirate. Treatment required surgical drainage besides a double antibiotic regimen. The patient was discharged on fluticasone propionate pressurized aerosol delivered via babyhaler and was doing well on follow-up. One possible explanation for the primary Streptococcus viridans pneumonia in this girl is aspiration favoured by forcible dry powder inhalation of her anti-asthma drug. The severity of the pneumonia and extension into the pericardium were probably linked to the antimicrobial resistance of the agent.