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Left Atrial Myxoma Surgery in Cryoglobulinemic Vasculitis Associated with Hepatitis B: A Clinical Case Report
Iustina Maria Andrieș1, Radu Sebastian Gavril1,2, Cristina Andreea Adam1
1Grigore T. Popa University of Medicineand Pharmacy, 700115 Iasi, Romania.
Insights
This case study details a 75-year-old woman’s complex recovery after left atrial myxoma surgery, highlighting secondary cryoglobulinemic vasculitis linked to chronic hepatitis B infection and hepatic activity.
Area of Science:
- Cardiology
- Immunology
- Hepatology
Background:
- Left atrial myxoma is the most common benign cardiac tumor, requiring surgical excision.
- Postoperative cardiovascular rehabilitation is crucial for patient recovery.
- Comorbidities like hypertension and chronic hepatitis B virus (HBV) infection complicate management.
Abstract:
Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical-Etiological-Anatomical-Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes.
