SummaryCardiac tumors and tumor-like lesions are uncommon; most are true neoplasms. We here report a case of a pericoronary tumor-like lesion surrounding the right coronary artery in a 39-year-old man who presented with fever and chest pain. Although clarithromycin was administered for 1 week, his fever persisted. Helicobacter cinaedi (H. cinaedi) was isolated from blood cultures and found to be sensitive to ceftriaxone. A computed tomography scan showed a tumor-like lesion with no 18 F-fluorodeoxyglucose uptake surrounding the right coronary artery. After administration of ceftriaxone, the tumor-like lesion diminished in size according to meticulous computed tomography examinations. We therefore concluded that it was caused by H. cinaedi infection. The patient has been followed up closely for 1 year and remains asymptomatic. (Int Heart J 2014; 55: 463-465) Key words: Cardiac tumor, PET-CT P rimary cardiac tumors are uncommon; most are neoplasms. However, some tumor-like lesions are reactive, pseudoneoplastic masses. 1) Possible pathogenetic mechanisms include inflammation, autoimmune disorders, and infections.2-5) Helicobacter cinaedi is commonly isolated from compromised patients; however, there are increasing reports of this organism infecting immunocompetent patients. [6][7][8] H. cinaedi infection is reportedly associated with cardiovascular disease.9,10) We here report a case of a pericoronary pseudotumor caused by H. cinaedi.
Case ReportA 39-year-old man presented to another institution with fever and chest pain. His white blood cell count was 19,440/ μL, and serum C-reactive protein concentration 11.2 mg/dL. Pneumonia was suspected and 400 mg of clarithromycin per day was administered orally for 1 week. However, his fever persisted and H. cinaedi was isolated from blood cultures, after which 2 g per day of intravenous ceftriaxone was substituted for clarithromycin for 2 weeks. Because infective endocarditis was suspected, transthoracic echocardiography was performed. This showed a mass on the lateral side of the right atrium and ventricle. A computed tomography (CT) scan showed a 5.8 × 4.2 cm tumor-like lesion around the right coronary artery (Figure 1). After he had received ceftriaxone for 2 weeks, the results of blood examinations returned to within normal limits and he was referred to our hospital for a suspected cardiac tumor.On presentation to our hospital, his physical examination was normal. White blood cell count was 4,720/μL with a normal differential count and the C-reactive protein concentration was within normal limits. Biochemical data, including serum immunoglobulin concentrations, were unremarkable. Tumor markers such as carcinoembryonic antigen, cancer antigens 19-9 and 125, α-fetoprotein, squamous cell carcinoma antigen, interleukin-6, and soluble interleukin-2R were all within normal limits. There was no evidence of immune deficiency and HIV serology was negative. Chest X-ray films showed no cardiomegaly or any other abnormalities. Electrocardiography showed normal sinus rhythm with...