Myocardial calcification in a post-heart transplant patient

This case report describes a rare occurrence of extensive myocardial calcification (MC) in a 26-year-old heart transplant (HTx) recipient. The patient presented with features of acute heart failure with severe biventricular dysfunction. His hemodynamics deteriorated rapidly, leading to multiorgan failure and death despite maximal pharmacological and mechanical circulatory support. He was treated on the Line of acute allograft rejection, but his condition took a rapid downward spiral ending in death. Post-mortem histopathological examination of myocardial tissue detected diffuse MC, Grade 1 acute cellular rejection (ACR 1R, International Society for Heart & Lung Transplantation 2004) and Grade 0 antibody-mediated rejection. This case emphasized that MC can rapidly progress and prove fatal in HTx patients, particularly when associated with conditions such as acute rejection, severe myocardial dysfunction/failure, high-dose inotropes, sepsis, and acute renal failure on hemodialysis. Clinicians should maintain a high index of suspicion for severe allograft rejection with dystrophic MC in rapidly deteriorating HTx recipients, refractory to maximal support and anti-rejection therapy.