Silent Cardiac Rupture Unmasked by Routine Echocardiography During Persistent Staphylococcus aureus Bacteremia.

Authors

David Neuhalfen, Pablo Dominguez-Erquicia, Ana Ledo-Piñeiro, Miguel A Piñón-Esteban, Miriam Vazquez-Lamas, David Dobarro, Andrés Iñiguez-Romo

Published in

JACC. Case reports. Pages 109404. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Postinfarction mechanical complications are rare in the primary percutaneous coronary intervention era. We report a silent, contained left ventricular free wall rupture driven by persistent staphylococcal bacteremia in an immunomodulated patient.
A 64-year-old man with active ulcerative colitis on corticosteroids and vedolizumab presented with an anterior ST-segment elevation myocardial infarction, complicated by early stent thrombosis. He developed persistent Staphylococcus aureus bacteremia; transesophageal echocardiography excluded endocarditis. Although clinically stable, routine echocardiography on postinfarction day 24 detected a silent contained free wall rupture. Surgery revealed hemato-purulent pericardial effusion with culture-confirmed Saureus. After initial recovery, a ventricular septal defect developed, requiring percutaneous closure. The patient died 2 months postinfarction.
To our knowledge, this is the first antemortem diagnosis of sequential postinfarction mechanical complications driven by confirmed staphylococcal infection of necrotic myocardium without endocarditis.
Persistent Saureus bacteremia after infarction warrants comprehensive evaluation beyond endocarditis. Structured echocardiographic surveillance can detect silently evolving mechanical complications.

PMID:
42667289
Bibliographic data and abstract were imported from PubMed on 29 Aug 2026.

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