A Case of Left Ventricular Pseudoaneurysm Developed from Myocardial Abscess

The patient was a 57-year-old woman who had undergone maintenance hemodialysis due to diabetic nephropathy. She suddenly developed high fever of 40°C, lumbago and epigastralgia with hypotension and was diagnosed as having septic shock requiring vasopressors and endotoxin adsorption therapy. Laboratory test demonstrated severe inflammation and methicillin sensitive Staphylococcus aureus was cultured from blood samples, but clear source of infection was not detected. After the administration of specific intravenous antibiotics, inflammatory data gradually declined, but 10 days later, she developed high fever and pericarditis. Echocardiogram disclosed pericardial effusion and calcification of the posterior mitral leaflet but vegetation was not detected. Although the aspiration was negative for bacterial growth, we diagnosed her as bacterial pericarditis and continued the administration of antibiotics for four weeks. Thereafter she got well and discharge. One month later, she visited our hospital with anorexia and computed tomography revealed a large pseudoaneurysm of the posterior left ventricular wall just below the posterior mitral valve leaflet. She underwent emergent surgery. The left ventricular aneurysm orifice was closed. If patients on hemodialysis become complicated by long term fever, we need to pay attention to the onset of infective endocarditis.