Myocardial Calcification as a Rare Cardiac Sequela: When Sepsis Leaves Its Mark.

BACKGROUND

Myocardial calcification is a rare complication of severe sepsis that may lead to persistent structural and functional cardiac impairment.

CASE SUMMARY: A 33-year-old woman presented in septic shock with severe acute respiratory distress syndrome due to disseminated Streptococcus pneumoniae. Her course was complicated by marked troponin elevation (6,254 ng/L) with normal coronary angiography. Initial chest computed tomography showed bilateral pulmonary consolidations. Four weeks later, repeat computed tomography revealed new extensive left ventricular and papillary muscle calcifications. Sepsis-related myocardial calcification was favored. She remained clinically stable on guideline-directed medical therapy. At 1.5-year follow-up, cardiac magnetic resonance demonstrated mild left ventricular dysfunction with extensive nonischemic late gadolinium enhancement.

DISCUSSION: Sepsis-related myocardial calcification is rare and associated with very high mortality rates. Its pathophysiology is unclear. Proposed mechanisms include myocardial injury, microvascular dysfunction, and metabolic disturbances.

TAKE-HOME MESSAGES: Myocardial calcification may develop rapidly after septic shock despite normal initial imaging. Multimodality imaging facilitates early diagnosis and appropriate management.