Multiple infected cardiac myxoma in young female patient complicated with multiple systemic infarctions: case report and review of literature

BACKGROUND: Cardiac myxomas are the most common primary heart tumors, yet their occurrence in young patients, particularly when infected and leading to multiple systemic infarctions, is exceedingly rare. This case highlights the critical need for early diagnosis and intervention. An 18-year-old female presented with orthopnea, low-grade fever, chest tightness, and pulmonary edema. She had experienced dyspnea, weight loss, recurrent abdominal pain, and chronic anemia over the past six months. Examination revealed congested lungs, sweating, tachycardia, and laboratory findings indicative of inflammation. Echocardiography identified multiple obstructing masses in the left atrium moving into the left ventricle during diastole, causing severe mitral regurgitation. Imaging revealed old infarcts in the brain, liver, and spleen. Blood cultures were positive for Enterococcus faecalis, and empirical antibiotics were initiated. Urgent surgery was performed, including left atrial myxoma resection, mitral valve replacement with a bioprosthetic valve, left atrial appendage closure, and closure of the interatrial septum. Postoperative echocardiography confirmed normal left ventricular function and a well-functioning bioprosthetic mitral valve. The patient tolerated the procedure well and was discharged on a regimen of oral antibiotics for six weeks. DISCUSSION: Infected cardiac myxomas, though rare, pose significant risks due to their potential for systemic embolization and severe complications. This case emphasizes the necessity of comprehensive diagnostic evaluation and timely surgical intervention to prevent catastrophic outcomes. CONCLUSION: This case underscores the importance of a multidisciplinary approach and early surgical intervention in managing complex cases of infected cardiac myxoma with systemic embolization. Our findings reinforce the need for vigilance in diagnosing and treating such rare but life-threatening conditions.