Extensive myocardial infiltration by hemopoietic precursors in a patient with myelodysplastic syndrome

Herein we report the first case of neoplastic infiltration of the heart with associated myocardial necrosis in a patient with myelodysplasia. It was associated with unicellular and multifocal geographic areas of necrosis in the left ventricle and the interventricular septum. It is likely that cardiac compromise in our patient was due to a combination of restrictive cardiomyopathy due to leukemic infiltration, concomitant anemia, cardiac dilatation, conduction blocks and myocardial necrosis. Myocardial necrosis was most likely due to a combination of ischemic damage secondary to anemia and prolonged hypotension and extensive leukemic infiltration. Markedly rapid decrease in ejection fraction from 66% to 33% also suggests the role of ischemia, since leukemic infiltration is not expected to cause this degree of systolic dysfunction over a 24-hour period. The diagnosis was not suspected during life due to concomitant signs and symptoms of anemia, pulmonary infections, and pericardial and pleural effusions. The patient succumbed to cardiac failure.Hemopoietic cell infiltration was not considered in the differential diagnosis and contributed to this patient's morbidity and mortality. This case highlights the clinical importance of considering myocardial infiltration in patients with myelodysplasia and cardiac symptoms.Myelodysplastic syndromes are hematologic malignancies characterized by dyspoiesis, a progressive clinical course and usually a fatal outcome due to either transformation to acute leukemia or bone marrow failure [1,2]. The patients often present with symptoms attributable to cytopenias and the clinical course reflects progression to bone marrow failure or transformation to acute leukemia [3]. The patients usually managed with supportive care and sometimes novel treatments [4] are monitored for evolution to acute leukemia and progressive marrow failure using some risk stratification scheme, for instance the International Prognostic Scoring System [5].Cardiac