Acute Severe Mitral Regurgitation Following Blunt Chest Trauma and a Febrile Illness in a Young Adult With Degenerative Mitral Valve Disease: A Rare Case Report

Acute severe mitral regurgitation (MR) in young adults is rare and is usually associated with infective endocarditis, trauma, congenital abnormalities, or connective tissue disorders. However, acute presentation of degenerative mitral valve disease is uncommon in young adults. A 23-year-old man developed acute pulmonary edema following blunt precordial trauma during a football match, with a brief febrile illness occurring several days later. Transthoracic echocardiography demonstrated acute severe eccentric MR due to flail of the P2 scallop resulting from the rupture of the chordae tendineae. Comprehensive evaluation, including blood cultures, infectious workup, cardiac magnetic resonance imaging, and histopathological analysis, excluded infective endocarditis and myocarditis. The patient underwent urgent mitral valve repair with triangular P2 resection, neochordal reconstruction, and annuloplasty ring implantation. Histopathology revealed underlying myxomatous degeneration. This case raises the possibility of a “two-hit” mechanism in which pre-existing myxomatous degeneration created structural vulnerability and the subsequent blunt chest trauma occurred in temporal proximity to chordal rupture. The accompanying febrile inflammatory state provides a hypothesis-generating biological context, but its contribution to chordal weakening or rupture cannot be established from this case.