A case of septic shock which postmortem pathological autopsy revealed bacterial myocardial abscess

Background and purpose: The myocardial abscess is a scarce condition, but it is significant due to its high mortality. We aimed to seek insight into myocardial abscess by presenting a case report.

Methods: A 73 years old male was emergently transferred to our hospital with disorientation and hypotension. He had a past medical history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and calculous cholecystitis. He had complained of lumbago since 1 week before arrival at our hospital. We diagnosed him with septic shock due to pyogenic spondylitis and psoas abscess by the laboratory and imaging findings. We could not find abnormality in his cardiac status of echocardiography. Despite the treatment, his condition worsened rapidly, and he died after 24 hours of arrival. We performed a postmortem pathological autopsy, which revealed the condition of myocardial abscesses. We examined medical literature about a myocardial abscess.

Results: According to a previous treatise, pyogenic spondylitis was reported as a causative disease of the myocardial abscess to the same extent as infective endocarditis. Bacterial myocarditis may lead to decreased cardiac function and arrhythmias. Our case did not show cardiac asynergy, decreased cardiac function, and sudden fatal arrhythmias during the course. We thought that the myocardial abscess was due to a hematogenous metastasis from the pyogenic spondylitis. And we thought the direct cause of death was septic shock, not the myocardial abscess.

Conclusions: We experienced a fatal septic shock case that revealed myocardial abscess by the postmortem pathological autopsy. It is possible that we cannot notice the existence of myocardial abscess without a pathological autopsy.