Three's Company: Cardiac myxoma, bicuspid aortic valve with severe aortic stenosis and ascending thoracic aortic aneurysm uncovered by anaplasmosis infection.

A 62-year-old man presented to the emergency department with chest pain, nausea, fever and hypotension consistent with sepsis. A contrast-enhanced CT revealed a 5.5 cm ascending thoracic aortic aneurysm, bicuspid aortic valve, and a left atrial mass. Transesophageal echocardiography showed a tumor in the left atrium attached to the fossa ovalis. Infectious evaluation was undertaken, and polymerase chain reaction was positive for anaplasmosis. Coronary angiography found severe coronary artery disease. After completing a course of antibiotics and recovering from his acute illness, the patient underwent left atrial tumor resection, aortic valve replacement, aortic aneurysm repair, and coronary artery bypass grafting. Pathology confirmed the tumor was a myxoma. This case illustrates that allowing time for clinical stabilization and completion of a course of antibiotics for sepsis due to anaplasmosis prior to urgent cardiovascular surgery may be a reasonable approach.