A Case of Infected Left Atrial Myxoma Presenting as ST-Elevation Myocardial Infarction (STEMI)

• Published in: The American journal of case reports Vol. 20; pp. 1930 - 1935
• Main Authors: Peters, Matthew J, Tuwairqi, Khaled W, Farah, Michel G
• Format: Journal Article
• Language: English
• Published: United States International Scientific Literature, Inc 24.12.2019
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Ceftriaxone - therapeutic use; Coronary Angiography; Coronary Thrombosis - surgery; Diagnosis, Differential; Echocardiography, Transesophageal; Electrocardiography; Gentamicins - therapeutic use; Heart Neoplasms - microbiology; Heart Neoplasms - surgery; Humans; Male; Myxoma - microbiology; Myxoma - surgery; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction - microbiology; Streptococcal Infections - drug therapy; Streptococcal Infections - microbiology; Streptococcus - drug effects; Streptococcus - isolation & purification
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.918192

BACKGROUND Although left atrial myxoma is the most common benign primary cardiac tumor, infected atrial myxoma is rare. This report presents a case of infected left atrial myxoma with embolization to the left anterior descending (LAD) coronary artery, which was identified following an initial presentation with ST-elevation myocardial infarction (STEMI). CASE REPORT A 34-year-old man with a history of smoking tobacco and intravenous cocaine use presented to the emergency room with symptoms of a feeling of pressure on the chest and symptoms in the left arm. An electrocardiogram (ECG) showed ST elevation in leads II, III, aVF, and V3-V5, consistent with an anterior-inferior STEMI. He underwent percutaneous intervention (PCI) with two drug-eluting stents to the mid-distal LAD coronary artery. The patient also had fever, chills, a history of weight loss, and signs of peripheral emboli. Blood cultures identified Gram-positive Streptococcus parasanguinis, a member of the Streptococcus viridans group. Transesophageal echocardiogram (TEE) identified a large, mobile, pedunculated left atrial mass protruding into the mitral valve in diastole and mitral valve vegetations. Surgical excision and the histology confirmed a diagnosis of benign left atrial myxoma containing Gram-positive cocci. The patient required mitral valve replacement and a postoperative two-week course of gentamicin and a six-week course of ceftriaxone CONCLUSIONS A rare case is reported of infected left atrial myxoma presenting as STEMI secondary to coronary artery embolization, which was treated with PCI, antibiotics, and mitral valve replacement.