Cardiac myxoma misdiagnose as infective endocarditis in a patient with acute limb ischemia and cardioembolic cerebral stroke: a case report

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Introduction: Fever, systemic embolism, and intra-cardiac masses are all symptoms of Infective Endocarditis (IE) and Cardiac Myxoma (CM)1. As a result, despite proper imaging studies, these diseases are frequently misdiagnosed one for the other.2 Case description: A 23-years-old female patient was admitted to emergency department of Zainoel Abidin General Hospital with acute onset right lower extremity pain for the last few hours and presented roth spots of the retina. The next day after admission, she presented fever. The patient denied having chronic disease, drug abuse, and thrombotic history. Tooth decay were found. Transthoracic Echocardiography (TTE) were obtained due to concern of infective endocarditis. Head CT-scan revealed cardioembolic cerebral stroke. TTE showed ejection fraction 56%, severe mitral regurgitation, and a mobile mass size 3.1x2.4 cm in mitral valve, attached to anterior mitral leaflet. The patient underwent thrombectomy, stroke therapy, dental tooth decay treatment, and lower limb rehabilitation at that moment, before having Mitral Valve Replacement (MVR) surgery. Six months afterward MVR surgery was done, rather than vegetation, we found a 50cc cardiac myxoma in anterior mitral valve leaflet. A 27mm bioprosthetic valve was installed. The patient was recovered quickly and she was able to discharge from hospital in the next 7 days after procedure without any further issue. Conclusion: In order to effectively manage the patients, it is crucial to distinguish between IE and cardiac myxoma. The mainstay of treatment for cardiac myxoma cases is surgery, which has an excellent prognosis. To evaluate for recurrence, long-term follow-up is frequently required.