Early detection and progression of sepsis-related myocardial calcification with subsequent left ventricular systolic dysfunction: a case report


      Sepsis-related myocardial calcification (SRMC) is a life-threatening complication. However, it is a rare entity and its clinical course is not well-understood. A 54-year-old man after bone graft surgery presented with septic shock due to surgical site infection. The initial computed tomography (CT) showed no deposit of calcium in the left ventricle (LV), and echocardiography demonstrated preserved left ventricular ejection fraction (LVEF) of 61%. On the 10th day of admission, CT detected new-onset LV myocardial calcification with preserved LVEF of 60% in echocardiography. On the 63rd day, follow-up CT revealed an increased density of the calcified lesion in the LV, and echocardiography showed a significantly reduced LVEF of 30%. This case report clarified a clinical course of SRMC that the calcium deposit began early after the onset of sepsis and LV systolic function declined subsequently along with the progression of the LV calcification. A serial assessment of CT and echocardiography from the initial stage in sepsis could be helpful for early detection and appropriate management of SRMC patients.
      Learning objective:Sepsis-related myocardial calcification (SRMC) is under-diagnosed in daily clinical practice because most cases progress silently. By serially assessing computed tomography and echocardiography in patients with sepsis from the initial stage, we can detect SRMC early and follow a change in the calcium in the left ventricle (LV) and LV function.>


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        • Nance Jr, J.W.
        • Crane G.M.
        • Halushka M.K.
        • Fishman E.K.
        • Zimmerman S.L.
        Myocardial calcifications: pathophysiology, etiologies, differential diagnoses, and imaging findings.
        J Cardiovasc Comput Tomogr. 2015; 9: 58-67
        • van Kruijsdijk R.C.
        • van der Heijden J.J.
        • Uijlings R.
        • Otterspoor L.C.
        Sepsis-related myocardial calcification.
        Circ Heart Fail. 2011; 4: e16-e18
        • Torfs M.
        • Salgado R.
        • Van Herck P.
        • Corthouts B.
        • Robert D.
        • Parizel P.M.
        A curious case of acute myocardial calcifications.
        Circulation. 2016; 133: e426-e427
        • Cappelletti S.
        • Piacentino D.
        • Ciallella C.
        A systematic review of radiological and histological findings of septic myocardial calcifications.
        J Forensic Leg Med. 2020; 74102026
        • GORE I.
        • ARONS W.
        Calcification of the myocardium; a pathologic study of 13 cases.
        Arch Pathol (Chic). 1949; 48: 1-12
        • Catellier M.J.
        • Chua G.T.
        • Youmans G.
        • Waller B.F.
        Calcific deposits in the heart.
        Clin Cardiol. 1990; 13: 287-294
        • Sato R.
        • Nasu M.
        A review of sepsis-induced cardiomyopathy.
        J Intensive Care. 2015; 3: 48
        • Dederer J.
        • Custodis F.
        • Fries P.
        • Böhm M.
        Fleckenstein's hypothesis revisited: excessive myocardial calcification after prolonged high dose catecholamine treatment: a case report.
        Eur Heart J Case Rep. 2018; 2: yty126
        • Lim A.
        • Be K.K.
        • Wong C.
        A case report: extensive myocardial calcification and non-ischaemic cardiomyopathy related to past sepsis.
        Eur Heart J Case Rep. 2021; 5: ytaa564
        • Rostand S.G.
        • Sanders C.
        • Kirk K.A.
        • Rutsky E.A.
        • Fraser R.G.
        Myocardial calcification and cardiac dysfunction in chronic renal failure.
        Am J Med. 1988; 85: 651-657