Extensive myocardial calcification following cytokine release syndrome and sepsis: a novel case report with advanced echocardiographic assessment

TL;DR

A patient with leukemia developed rare heart calcification after a severe immune reaction and sepsis, detected using advanced imaging techniques.

Contribution

First reported case of rapid myocardial calcification linked to cytokine release syndrome and sepsis, using advanced echocardiographic methods.

Findings

Computed tomography revealed extensive left ventricular myocardial calcification in a patient with acute myeloid leukemia.

Advanced echocardiography showed progressive systolic dysfunction and impaired contractility despite preserved global work efficiency.

Abstract

Myocardial calcification is a rare complication, typically associated with chronic myocardial injury or severe metabolic disturbances. Rapid development in the setting of cytokine release syndrome (CRS) and sepsis is exceptional and, to our knowledge, has not been previously reported.

We describe a 44-year-old man with acute myeloid leukaemia who developed CRS and subsequent septic shock, requiring high-dose vasopressor support and continuous renal replacement therapy. On day 70 of hospitalization, a computed tomography scan revealed extensive intramyocardial calcification of the left ventricle. Serial transthoracic echocardiography demonstrated progressive systolic dysfunction, with global longitudinal strain deteriorating from −22% to −9%, and a markedly reduced global work index (GWI 780 mmHg%), indicating impaired intrinsic contractility. Global work efficiency (GWE 96%) remained preserved.

This is the first reported case of rapidly progressive myocardial calcification associated with CRS, documented using advanced non-invasive imaging modalities such as GLS and myocardial work. These techniques enabled early detection and objective assessment of functional decline in a critically ill patient, in whom conventional diagnostic options were limited.

Figures