Infected cardiac myxoma. Case report and literature review

We present a case of a left atrial myxoma infected with Porphyromonas asaccharolytica in a 55-year-old man, successfully treated with surgical excision and a brief course of antibiotic therapy. Infected cardiac myxomas are extremely rare, with only 39 cases previously reported. They can be difficult to diagnose due to their protean clinical manifestations, which can often be seen in uninfected myxomas as well. We suggest that blood cultures and careful pathologic examination be performed in all cases of cardiac myxoma with constitutional symptoms. However, fever and elevated sedimentation rate are significantly more common in infected tumors. Organisms responsible are similar in distribution to those causing bacterial endocarditis. Emboli, though frequent, may not be more common in infected than uninfected myxomas. Case reports have become more common since the development of better diagnostic techniques. Echocardiography, especially by the transesophageal approach, is the diagnostic procedure of choice, and sensitivity approaches 100%. Surgical excision is curative and generally has low morbidity and mortality.