Rapidly progressive myocardial calcification following sepsis

Sepsis is a clinical syndrome caused by a dysregulated host response to infection that can lead to multiple organ dysfunction and death. Cardiovascular abnormalities are frequent in sepsis and may result in myocardial injury unrelated to coronary artery disease. Myocardial calcification is a rare complication of sepsis, which shows rapid-onset extensive myocardial calcifications. We present a case of a 67-year-old man who developed severe sepsis complicated with shock, acute renal failure, and acute respiratory distress syndrome. Initial chest computed tomography (CT) on admission showed normal left ventricular (LV) myocardial attenuation. However, serial chest CT demonstrated a gradual increase of the LV myocardial attenuation, which ultimately resulted in extensive myocardial calcification within 6 weeks. Sepsis-related myocardial calcification is usually found in patients with severe sepsis complicated with hemodynamic failure requiring vasopressors, acute renal failure necessitating renal replacement therapy, and acute respiratory distress syndrome. Although the prognostic significance of this pathology is unclear, it may be a precursor to long-term irreversible cardiomyopathy or an arrhythmogenic substrate that induces life-threatening arrhythmias. Therefore, patients who have survived the acute phase of severe sepsis need to be monitored carefully for signs of this complication by an imaging modality such as CT. <Learning objective: Sepsis is common and may cause myocardial injury. Myocardial calcification is an uncommon complication of sepsis, usually found in patients with severe sepsis. Sepsis-related myocardial calcification is classified as dystrophic, and represents the sequelae of local tissue damage and cellular necrosis. With sepsis-related myocardial calcification, rapid-onset extensive myocardial calcifications can develop within the course of 1 to 3 months. Patients who have survived the acute phase of severe sepsis need to be monitored carefully for signs of this complication.>.