Introduction: Very few cases of myocardial abscess are reported in medical literature. Although a rare disease entity in the developed countries, it carries a very high mortality rate and hence requires prompt diagnoses and treatment. Here we report a case of myocardial abscess diagnosed on autopsy.
Case Report: A 47-year-old patient with complaints of progressively worsening shortness of breath, abdominal pain and chest pressure from three days. Electrocardiography showed ST segment elevations in leads I, II, III, aVR, aVL, V2-V6. Emergency room team suspected ST segment elevation myocardial infarction (STEMI) and cardiology department was consulted for emergent cardiac catheterization. Due to high clinical suspicion of severe sepsis, the decision was made to hold off on cardiac catheterization. The patient was transferred for emergent computed tomography scan to rule out intra-abdominal infection. While in the scanner, patient developed pulseless electrical activity (PEA) arrest and passed away despite attempted resuscitation.
Conclusion: Myocardial abscess should be considered in patients presenting with conduction defects and ST segment elevations on ECG in the setting of suspected bacteremia or endocarditis. Transthoracic echocardiogram, transesophageal echocardiogram and nuclear medicine scans can all contribute to timely diagnoses. Definitive treatment of myocardial abscess involves surgical drainage. Due to high mortality associated with this disease, prompt diagnoses and treatment is of utmost importance.

Keywords: STEMI, Myocardial Abscess, Pericarditis