Myocardial Calcification as a Rare Cardiac Sequela: When Sepsis Leaves Its Mark

Myocardial calcification is a rare complication of severe sepsis that may lead to persistent structural and functional cardiac impairment.

A 33-year-old woman presented in septic shock with severe acute respiratory distress syndrome due to disseminated Streptococcus pneumoniae. Her course was complicated by marked troponin elevation (6,254 ng/L) with normal coronary angiography. Initial chest computed tomography showed bilateral pulmonary consolidations. Four weeks later, repeat computed tomography revealed new extensive left ventricular and papillary muscle calcifications. Sepsis-related myocardial calcification was favored. She remained clinically stable on guideline-directed medical therapy. At 1.5-year follow-up, cardiac magnetic resonance demonstrated mild left ventricular dysfunction with extensive nonischemic late gadolinium enhancement.

Sepsis-related myocardial calcification is rare and associated with very high mortality rates. Its pathophysiology is unclear. Proposed mechanisms include myocardial injury, microvascular dysfunction, and metabolic disturbances.

Myocardial calcification may develop rapidly after septic shock despite normal initial imaging. Multimodality imaging facilitates early diagnosis and appropriate management.