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A surgical case of infected cardiac myxoma
Shintaro Kuwauchi1, Mitsuharu Hosono1, Tomohiko Uetsuki1
1Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan.
Insights
Infected cardiac myxoma, a rare condition, was successfully treated with surgery and antibiotics. Prompt diagnosis and treatment are crucial for better patient outcomes in such cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Cardiac myxomas are typically benign tumors, but can rarely become infected, leading to significant complications.
- Fever of unknown origin can be a presenting symptom of various conditions, including cardiac infections.
Observation:
- A 60-year-old woman presented with fever of unknown origin, elevated inflammatory markers, and a left atrial tumor.
- Echocardiography and MRI revealed a large left atrial tumor with evidence of microinfarcts.
- Surgical resection of the tumor showed it to be a cardiac myxoma with surface bacterial colonization.
Findings:
- Histopathology confirmed cardiac myxoma infected with Streptococcus vestibularis.
- The patient's elevated white blood cell count, C-reactive protein, and interleukin-6 supported an infectious process.
- Blood cultures were positive for Streptococcus vestibularis, confirming the causative agent.
Implications:
- Infected cardiac myxoma requires prompt diagnosis and combined surgical and antibiotic treatment.
- Early and effective intervention, including complete tumor resection and appropriate antibiotics, improves patient prognosis.
- This case highlights the importance of considering cardiac myxoma in patients with unexplained fever and cardiac masses.
Abstract:
A 60-year-old woman presented with a fever of unknown origin. Echocardiography revealed a large left atrial tumor protruding into the left ventricle during diastole. Laboratory investigation showed an elevated white blood cell count, C-reactive protein concentration, and interleukin-6 concentration. Magnetic resonance imaging showed hyperacute microinfarcts and multiple old lacunar infarcts. Surgery was performed under suspicion of cardiac myxoma. A dark red jelly-like tumor with an irregular surface was removed. Histopathological examination revealed cardiac myxoma, the surface of which was covered with fibrin and bacterial masses. Preoperative blood culture was positive for Streptococcus vestibularis. These findings were compatible with a diagnosis of infected cardiac myxoma. We used an antibiotic therapeutic regimen for infective endocarditis, and the patient was discharged home on postoperative day 31. Prompt diagnosis and treatment, including effective and efficient antibiotic therapy and complete tumor resection, increased the chance of a better outcome in patients with infected cardiac myxoma.
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