Post-Cardiac Injury Syndrome Presenting as Fever of Unknown Origin After TAVI: A Case Report

Background Post-cardiac injury syndrome (PCIS) is an inflammatory condition that may develop after cardiac procedures. Fever-dominant presentations without pericarditic chest pain are uncommon and may delay diagnosis. Case presentation A 66-year-old man developed persistent fever up to 39.5°C approximately two months after transcatheter aortic valve implantation (TAVI). C-reactive protein was 151 mg/L, while serial procalcitonin measurements were negative. Blood cultures obtained before antibiotics and investigations for Bartonella and Brucella were negative. Computed tomography revealed splenic collections; aspiration yielded old blood with negative cultures, supporting the interpretation of sterile splenic haematomas. Transoesophageal echocardiography showed a normally functioning prosthesis without vegetations and a small circumferential pericardial effusion. Cardiac magnetic resonance (CMR) imaging demonstrated pericardial late gadolinium enhancement (LGE), supporting active pericardial inflammation. FDG-PET/CT was unavailable. Prednisone and colchicine were initiated, with resolution of fever within 48 hours and normalization of inflammatory markers within one week. Conclusion PCIS should be considered after TAVI in patients with unexplained fever, even without chest pain. CMR can support the diagnosis, while infective endocarditis must be carefully evaluated.