Septic myocardial calcification: A case report

Maiese, Aniello; Manetti, Federico; Russa, Raffaele La; Fazio, Nicola Di; Matteis, Alessandra De; Frati, Paola; Fineschi, Vittorio

doi:10.1016/j.jflm.2019.05.004

Cited by 8 publications

(13 citation statements)

References 13 publications

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“…Sledzinska et al [ 10 ] reported a case with just a focal contraction band necrosis of the heart. More specific septic-heart changes were described in three case reports from Rossi et al [ 11 ], Sinicina et al [ 12 ], and Maiese et al [ 13 ], who detected atrial and ventricular areas of increased consistency and brown-greenish discoloration, with widespread intra- and extracellular Ca 2+ deposition, interstitial perimysial fibrosis, myocytolytic myocytes, and inflammatory infiltrates mainly constituted by lymphocytes and multinucleated giant cells.…”

Section: Resultsmentioning

confidence: 91%

“…The pathophysiological events underlying sepsis have a strong impact on the function of each organ [ 1 , 3 , 7 ] since the organ failure induced gives rise, in most cases, to morphological alterations that can be evaluated both macroscopically and microscopically. We start by suggesting some works describing the main post-mortem macroscopic and histological changes ( Table 1 ) detected on septic organs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…The unspecific changes usually detected in lungs were congestion, oedema, haemorrhages, embolism [ 8 , 9 , 10 , 11 , 13 , 14 , 15 ], and pleural effusion [ 15 ]. In a retrospective analysis on 3030 lung autopsy samples, de Matos Soeiro et al [ 14 ], identified DAD (Diffuse Alveolar Damage) as the main histological finding ( n = 1374/3030), noting that the corresponding alterations (extensive alveolar collapse; prominent hyaline membranes; obliterative fibrosis; marked septa neoformation) were significantly prevalent in those patients suffering from sepsis or liver cirrhosis ( p < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…At external inspection, only rarely skin lesions/discolorations might address towards a specific infection [ 20 , 21 ]; at internal examination, many organs usually appear congested, or haemorrhagic, and may present infectious foci/abscesses, while fluid effusions or haemorrhages can be evaluated in serous membranes. The histological investigation might reveal variable leukocytic infiltrates, vascular thrombi, fibrosis, tissue damage signs, even microbial infiltrates [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Unfortunately, none of these signs are sensitive or specific, since each one reflects the effects of either a generic inflammatory insult, be it infectious or not, or a haemodynamic impairment of the organ function.…”

Section: Discussionmentioning

confidence: 99%

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Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

et al. 2020

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To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to allow a correct and definite post-mortem diagnosis. The review was conducted searching in PubMed and Scopus databases, and using variable combinations of the keywords “post mortem sepsis diagnosis”, “macroscopic signs”, “morphology”, “histology”, “immunohistochemical markers”, “biochemical markers”, and “forensic microbiology”. The article selection was carried out following specific inclusion and exclusion criteria. A total of 44 works was identified, providing data on morphological aspects of the organs examined, histological findings, immunohistochemical and biochemical markers, and cultural assays. The review findings suggested that the post-mortem diagnosis of sepsis can be achieved by a combination of data obtained from macroscopic and microscopic analysis and microbial investigations, associated with the increased levels of at least two of three biochemical and/or immunohistochemical markers evaluated simultaneously on blood samples.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

et al. 2020

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“…Based on previous reports, the diffused myocardial calcification is a life-threatening pathology and has a high mortality rate. In myocardial calcification that is associated with multiple organ dysfunction syndrome, both the 34year-old male patient reported by Lapatto Reiniluoto and the 72-year-old male patient reported by Aniello Maiese had died [2,6]. There were no articles reported that the calcified myocardium and myocardial depression were completely reversible in the surviving patients.…”

Section: Discussionmentioning

confidence: 99%

A case of bi-ventricular extensive calcification caused by multiple factors

Yang

et al. 2020

BMC Pediatr

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Background: Extensive myocardial calcification has a low incidence rate, but when the patients do have extensive myocardial cases, the prognosis is usually poor. Several sepsis-related extensive myocardial calcification cases have been reported, but there are cases of biventricular calcifications that are caused by multiple cases besides bacteremia and the treatment for it has a low percentage of success. Case presentation: A 9 year old girl had an extensive biventricular calcification which is caused by multiple factors including multiple organ failure (heart, lung, liver, and kidney), aseptic cardiomyopathy, systemic inflammatory response syndrome, pulmonary hemorrhage, viral encephalitis. In this case study, the massive myocardial calcification present in the patient was classified as dystrophic. After the patient was transferred to the Intensive care unit, a series of rescue treatments such as anti-inflammatory factor storm were implemented to protect the organs. In the end, the patient was rescued from the rescue treatment procedure. After 18 months of follow-up, it was observed that the patient's heart function returned to normal and it was observed that there was no change in myocardial calcification in the patient. Conclusion: In this case study, it showcased a case of the diffused biventricular calcification that caused by multiple factors. Furthermore, the precise role of calcification on cardiac function was largely unknown and there has to be further follow-up observation on the patient.

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