SHM Converge Scientific Abstract ePoster Gallery-Fever of the Heart: Evaluating a Case of Cardiac Myxoma

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A 59-year-old woman with MAFLD, GERD, OSA, and a recent uncomplicated cholecystectomy presented to the emergency department with rigors, lethargy, right-sided chest pain, fever, and sinus tachycardia. Because she met SIRS criteria, she was initially treated as having a presumed infection with broad-spectrum IV antibiotics. However, her early workup was unrevealing: blood cultures were negative, chest X-ray was normal, and labs showed no leukocytosis, with only transient liver enzyme and bilirubin elevations.<br /><br />Further history raised concern for unusual zoonotic exposure, including recent travel to Florida and petting kangaroos, so she was switched to doxycycline for possible Q fever while additional infectious testing was sent. Extensive infectious evaluation, including Bartonella, CMV, EBV, HIV, Legionella, strep pneumoniae, HSV, leptospirosis, hepatitis testing, and Q fever studies, was ultimately negative or non-diagnostic.<br /><br />Because she remained tachycardic and febrile without a clear source, CT pulmonary embolism imaging was obtained. This unexpectedly showed a filling defect in the left atrium. Echocardiography did not clearly define the lesion, but follow-up CT left atrial appendage imaging confirmed a small left atrial mass most consistent with an atrial myxoma. Cardiothoracic surgery was consulted, and outpatient MRI and surgical planning were arranged.<br /><br />The infectious workup being negative led Infectious Disease to conclude that the cardiac myxoma likely explained her constitutional symptoms, including fever. This case highlights that fever has a broad differential, and when infectious studies are persistently negative, alternative diagnoses and targeted imaging should be pursued. Cardiac myxomas are the most common primary cardiac tumor, often occurring in middle-aged women and commonly in the left atrium. They can present not only with obstructive cardiac symptoms, but also with indolent constitutional symptoms such as fever, malaise, and weight loss, likely related in part to IL-6 production.

Asset Subtitle

Sara J. Settle

Meta Tag

Author List Sara J. Settle

Category Clinical Vignettes

Concept Fever

Concept Fever of Unknown Origin

Concept Myxoma

Concept Constitutional Symptoms

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization University of Michigan

Presenting Author Sara J. Settle

Track Adult

Keywords

atrial myxoma

fever

SIRS

left atrial mass

infectious workup

doxycycline

zoonotic exposure

CT pulmonary embolism

constitutional symptoms

cardiac tumor

Fever

Fever of Unknown Origin

Myxoma

Constitutional Symptoms

Differential Diagnosis