Mitral Valve Mass in a Patient Suspected of Systemic Lupus: Tumor, Endocarditis or Both?

• Published in: Arquivos brasileiros de cardiologia Vol. 115; no. 6; pp. 1201 - 1204
• Main Authors: Coutinho, Thiago Sant'Anna, Almeida, Bárbara Cristina Rodrigues de, Amorim, Guilherme Dalcol Torres de, Zappa, Monica, Weksler, Clara, Lamas, Cristiane da Cruz
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 01.12.2020
• Subjects: Adult; Endocarditis - diagnostic imaging; Endocarditis - surgery; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - surgery
• ISSN: 1678-4170
• DOI: 10.36660/abc.20200206

We present a case report of a patient with an infected mitral valve myxoma and a literature review on the subject. A 33-year-old female presented with a history of fever and dyspnea evolving over a few days. On admission, she had a lupus-like syndrome with positive blood cultures for Haemophilus species . Echocardiogram revealed a giant mass involving both mitral leaflets causing severe regurgitation, requiring biological mitral valve replacement. Microscopy showed an infected myxoma and the patient was discharged asymptomatic upon completion of antibiotics. She did well on follow-up. This is the sixth case of an infected mitral valve myxoma reported in the literature and the third case of a cardiac myxoma infected by the HACEK group. Exceedingly high incidence of embolic events makes prompt imaging, antibiotic therapy and surgery crucial for better outcomes. Time to diagnosis was much briefer than usually reported in other cases of HACEK endocarditis. Valve replacement was the most common surgical procedure and all patients from previous reports did well on follow-up.