Myocardial abscess and fatal cardiac arrhythmia in a hemodialysis patient with an arterio-venous fistula infection.

Myocardial abscess formation is a life-threatening complication that is frequently but not exclusively associated with infective endocarditis. To our knowledge there are only two case reports of myocardial abscess formation in hemodialysis patients. Only one of these reports describes a myocardial abscess of bacterial etiology secondary to an infected intravascular hemodialysis catheter. Furthermore, there are no reports of bacterial myocardial abscess occurring in a hemodialysis patient with an infected arteriovenous fistula. Myocardial abscess can manifest in a variety of clinical scenarios ranging from an asymptomatic state to a catastrophic myocardial wall rupture. In the case described, the myocardial abscess lead to a rapidly progressive course consisting of recurrent cardiac arrhythmias that were ultimately fatal. Our case involved the formation of a myocardial abscess in the presence of a methicillin-resistant Staphylococcus aureus bacteremia without any evidence of infective endocarditis. We report this case to call attention to the possibility of bacterial myocardial abscess occurring with infection of an arteriovenous fistula in a hemodialysis patient, which can manifest as recurrent severe cardiac arrhythmias refractory to medical therapy.