FEVER OF UNKNOWN ORIGIN: A RARE MANIFESTATION OF CARDIAC MYXOMA

SHI-MIN YUAN, MD, PHD

Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People’s Republic of China

Introduction: Patients with cardiac myxoma typically present with one or more of the classic triad of obstructive, embolic and constitutional symptoms, but rarely present with fever of unknown origin. The clinical features, diagnotic dilemmas and management strategies of this rare condition have not been sufficiently elucidated.

Materials and methods: A comprehensive literature collection resulted in 58 pertinent articles with 62 patients, which consti- tute the study material of this research.

Results: Fever in this patient setting during hospitalization was 38.8 ± 0.7 (range, 37.4-40; median, 38.9) °C. The duration of fever was 6.4 ± 14.6 months. The time interval from the onset to the diagnosis of cardiac myxoma was 6.0 ± 6.1 months, and from physician consultation to the diagnosis was 1.4 ± 2.6 months. Poor responses to antimicrobial therapies were observed in at least 35% of the patients, and 4.9% were otherwise managed. Surgical resection of cardiac myxoma was performed in 48 (88.9%). Kaplan-Meier survival analysis revealed an overall survival rate of 87.0% with a survival of 95.5% in surgical and 16.7% in non- surgical groups.

Conclusion: Patients with cardiac myxoma presenting with fever of unknown origin pose challenges due to the nonspecific cli- nical manifestation. Elevated circulating levels of the inflammatory biomarkers including C-reactive protein and interleukin-6 are helpful in differential diagnosis between cardiac myxoma with FUO and infected cardiac myxoma. An early diagnosis of cardiac myxoma with FUO relies on a timely echocardiographic investigation. Due to its poor response to antibiotic therapy and immediate subside of fever following cardiac myxoma resection, a prompt surgical treatment is recommended up diagnosis is made.