A 58-year-old man developed hyper-acute diffuse myocardial calcification within four days during concomitant sepsis and viral myocarditis, followed by significant recovery of cardiac function.
Case Report (n=1)
No
This case demonstrates that diffuse myocardial calcification can develop hyper-acutely within four days due to sepsis and myocarditis, yet patients can still achieve significant cardiac recovery with early supportive management.
Abstract Background Myocardial calcification is typically a chronic process seen in long-standing conditions such as chronic kidney disease, where calcium-phosphate imbalance leads to metastatic calcification. In contrast, dystrophic calcification occurs acutely within necrotic cardiomyocytes and may develop rapidly, sometimes over days. While localized calcification can occur post-myocardial infarction, diffuse myocardial calcification is rare and has been reported in association with sepsis and myocarditis. Sepsis, a dysregulated host response to infection causing end-organ dysfunction, has been linked to sepsis-related myocardial calcification (SRMC), an exceedingly rare complication with fewer than 30 cases reported. Myocarditis, most often viral in etiology, can also cause myocardial injury predisposing to calcification. We present a unique case of rapid, diffuse myocardial calcification in a patient with concomitant Klebsiella pneumoniae sepsis and parainfluenza-associated myocarditis, with full manifestation detected within just four days. Case Presentation A 58-year-old man with hypertension, diabetes, and heavy alcohol use presented with fever, productive cough, and dyspnea. He was transferred from an outside hospital ICU for acute hypoxemic respiratory failure secondary to severe community-acquired pneumonia requiring intubation. Cultures grew Klebsiella pneumoniae bacteremia and parainfluenza virus on respiratory viral panel. On hospital day 1, he developed chest pain and ST-segment changes, underwent cardiac catheterization that showed non-obstructive coronary disease. Echocardiogram showed left ventricular ejection fraction (LVEF) of 52%. Myocarditis was suspected. By day 3, LVEF declined to 35-40%, requiring norepinephrine and phenylephrine for septic shock. On day 5, repeat CT chest revealed new left ventricular hyperattenuation consistent with myocardial calcification, absent on imaging 4 days prior. Throughout this time, calcium remained low-normal (7.7-9.2 mg/dL) and phosphate was initially elevated (6.7-7.6 mg/dL), then normalized. By day 9, repeat CT and echocardiography confirmed diffuse calcification with persistent hypokinesis but improved LVEF (49%). The patient clinically recovered and was discharged for outpatient heart failure follow-up. Discussion This case highlights hyper-acute diffuse myocardial calcification developing within four days in the setting of concomitant sepsis and viral myocarditis. Both sepsis-induced myocyte necrosis and myocarditis-related inflammation likely contributed synergistically to dystrophic calcification. While previously described SRMC cases often involve delayed detection, this report demonstrates one of the shortest intervals from onset to radiographic manifestation. Despite the grave prognosis typically associated with SRMC, our patient demonstrated significant recovery of cardiac function, suggesting early recognition and supportive management may improve outcomes. Continued follow-up is warranted to assess the long-term effects of persistent myocardial calcification. This abstract is funded by: None
Goldberg et al. (Fri,) conducted a case report in Myocardial calcification, sepsis, and myocarditis (n=1). A 58-year-old man developed hyper-acute diffuse myocardial calcification within four days during concomitant sepsis and viral myocarditis, followed by significant recovery of cardiac function.