Case Report

Fever of Unknown Origin: A Case of Cardiac Myxoma Infected with Staphylococcus lugdunensis

Authors: Nitin Bhanot, MD, MPH, Andrew G. Sahud, MD, Sunil Bhat, MD, Stacy Lane, DO, Harish Manyam, MD, Noreen H. Chan-Tompkins, PharmD

Abstract

Infected cardiac myxoma is a rare entity. It poses a diagnostic challenge as clinical presentation may reflect an underlying infectious, immune, or a neoplastic disease process. To the best of our knowledge, the first case of a cardiac myxoma infected withStaphylococcus lugdunensis is reported in a 54-year-old man with fever of unknown origin for 4 months. Successful excision of the tumor was performed and was followed by an uneventful recovery. Clinical presentation, diagnosis, and management of infected cardiac myxomas are discussed.


Key Points


* Diagnosis of a cardiac myxoma should be sought in a patient presenting with fever of unknown origin.


* Fever should not be solely attributed to myxoma, and clinical suspicion for an infected myxoma should be entertained, particularly in the event of concomitant blood stream infection.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. McManus B, Lee CH. Primary Tumors of the Heart, in Libby P, Bonow RO, Mann DL (eds):Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA, Saunders Elsevier, 2008, ed 8, pp 1815–1819.
 
2. Dick HJ, Mullin EW. Myxoma of the heart complicated by bloodstream infection by Staphylococcus aureus and Candida parapsilosis. N Y State J Med 1956;56:856–859.
 
3. Revankar SG, Clark RA. Infected cardiac myxoma. Case report and literature review. Medicine (Baltimore) 1998;77:337–344.
 
4. Yao F, Xu ZY, Liu YL, et al. Infective mitral valve myxoma with coronary artery embolization: surgical intervention followed by prolonged survival. J Thorac Cardiovasc Surg 2009;137:749–751.
 
5. Falasca K, Ucciferri C, Mancino P, et al. Infected atrial myxoma: a rare cause of fever. Infez Med 2008;16:40–42.
 
6. Janion M, Sielski J, Ciuraszkiewicz K. Sepsis complicating giant cardiac myxoma. Am J Emerg Med 2008;26:387.e3–387.e4
 
7. Leone S, dell'aquila G, Giglio S, et al. Infected atrial myxoma: case report and literature review. Infez Med 2007;15:256–261.
 
8. Chan V, Veinot JP, Hynes M, et al. Infected right ventricular myxoma and pulmonary valve endocarditis. J Thorac Cardiovasc Surg 2007;134:248–249.
 
9. Guler N, Ozkara C, Kaya Y, et al. Ruptured abdominal aortic aneurysm after resection of an infected cardiac myxoma. Tex Heart Inst J 2007;34:233–235.
 
10. Awab A, Hamadani M, Sud B, et al. Infected atrial myxoma. Med J Aust 2006;185:332.
 
11. Veitch AM, Manghat NE, Kakani NK, et al. Systemic septic embolisation secondary to an atrial myxoma in a young woman. Emerg Radiol 2006;12:137–139.
 
12. Quigley RL, Meursing DF, Rossman MI. Left atrial myxoma and mitral valve endocarditis—a cause and effect: a case report. Heart Surg Forum 2006;9:E486–E487.
 
13. Riad MG, Parks JD, Murphy PB, et al. Infected atrial myxoma presenting with septic shock. J Cardiothorac Vasc Anesth 2005;19:508–511.
 
14. a-Quintana A, Martín-Lorenzo P, Suárez de Lezo J, et al. Infected left atrial myxoma [in Spanish]. Rev Esp Cardiol 2005;58:1358–1360.
 
15. Karachalios G, Bablekos G, Karachaliou I, et al. Left atrial myxoma prolapsing into the left ventricle. Case report and review of the literature. Chemotherapy 2004;50:297–301.
 
16. Gregory SA, O'Byrne WT III, Fan P. Infected cardiac myxoma. Echocardiography 2004;21:65–67.
 
17. Prince JM, Larsen R, Janner D. Infected cardiac myxoma. Pediatr Infect Dis J 2002;21:177–178.
 
18. Uchino K, Mochida Y, Ebina T, et al. Infected left atrial myxoma. Intern Med 2002;41:957–960.
 
19. Tanaka M, Kawahito K, Adachi H, et al. Infected left atrial myxoma with mitral valve endocarditis. Jpn J Thorac Cardiovasc Surg 2002;50:137–139.
 
20. Dekkers P, Elbers HR, Morshuis WJ, et al. Infected left atrial myxoma. J Am Soc Echocardiogr 2001;14:644–645.
 
21. Puvaneswary M, Thomson D. Magnetic resonance imaging features of an infected right atrial myxoma. Australas Radiol 2001;45:501–503.
 
22. Toda R, Moriyama Y, Shiota K, et al. Myxoma of mitral valve associated with infective endocarditis. Jpn J Thorac Cardiovasc Surg 1999;47:285–287.
 
23. Tunick PA, Fox AC, Culliford A, et al. The echocardiographic recognition of an atrial myxoma vegetation. Am Heart J 1990;119:679–680.
 
24. Rogers KL, Fey PD, Rupp ME. Coagulase-negative staphylococcal Infections. Infect Dis Clin North Am 2009;23:73–98.
 
25. Flynn W, Garcia-Rinaldi R, Roehm JO Jr, et al. Surgical treatment of infected right atrial myxoma. Ann Thorac Surg 1979;27:242–245.
 
26. Kaplan LJ, Weiman DS, VanDecker W, et al. Infected biatrial myxoma: transesophageal echocardiography-guided surgical resection. Ann Thorac Surg 1994;57:487–489.