Rapid development of extensive myocardial calcification in a diabetic patient with multi-organ failure: a case report

Extensive myocardial calcification is a rare phenomenon typically associated with severe systemic illness. It may develop rapidly in critically ill patients following myocardial injury, particularly in the context of sepsis, vasoplegia, and profound metabolic derangements.

A 39-year-old man with poorly controlled type 1 diabetes mellitus presented in a comatose state due to severe diabetic ketoacidosis and hypothermia. Laboratory investigations revealed acute kidney injury, hypophosphataemia, and an elevated inflammatory profile. Initial imaging, including non-contrast CT, was unremarkable. During his ICU stay, he developed multi-organ failure with vasoplegia requiring high-dose vasopressors and transient cardiac dysfunction. On Day 14, he experienced an in-hospital cardiac arrest. Post-resuscitation CT unexpectedly revealed extensive calcification of the left ventricular myocardium, which had not been present on earlier imaging. Despite temporary haemodynamic stability, he suffered irreversible neurological injury and died on Day 19. Autopsy confirmed diffuse dystrophic myocardial calcifications without evidence of infarction or fibrosis.

This case illustrates rapid-onset dystrophic myocardial calcification occurring in the setting of severe metabolic and inflammatory stress. Prolonged vasopressor exposure, acidosis, and systemic inflammation likely contributed to myocardial injury and subsequent calcium deposition. Awareness of this rare complication may improve diagnostic vigilance and support early prognostic discussions in similar patients.