Multiple Intracardiac Tumors Causing Obstructive Shock Mimicking Sepsis in a Late Preterm Neonate

Abstract

Background:
Intracardiac tumors in neonates are rare, with cardiac rhabdomyoma being the most common primary cardiac tumor in this age group. Although many cases are asymptomatic and may regress spontaneously, large or strategically located lesions can result in significant hemodynamic compromise.
Case Presentation:
We report a late preterm male neonate who presented on day three of life with severe respiratory distress, shock, hypoglycaemia, and seizures. Initial evaluation showed presence of thrombocytopenia, metabolic acidosis and acute kidney injury with features suggesting septic shock. The infant was managed by mechanical ventilation, inotropic support, glucose infusion and administration of broad-spectrum antibiotics. Despite intensive care the clinical course was marked by recurrent episodes of desaturation as well as cyanosis. In view of cyanosis not responding to oxygen therapy echocardiography was done which revealed multiple well-circumscribed intracardiac masses involving the left atrium and left ventricle. There was also partial left ventricular inflow obstruction. Features on 2D Echo suggested cardiac rhabdomyoma. The infant subsequently developed refractory sepsis complicated by persistent thrombocytopenia, recurrent bleeding episodes and progressive clinical deterioration. Surgical intervention was deferred due to hemodynamic instability and ongoing sepsis. Despite aggressive supportive management, including blood product transfusions and
immunomodulatory therapy, the neonate suffered recurrent cardiac arrest and succumbed on day 21 of life.
Conclusion:
This case highlights a rare as well as fatal presentation of multiple intracardiac tumors causing functional inflow obstruction in a late preterm neonate. It underscores the importance of early echocardiographic evaluation in newborns with unexplained cyanosis accompanied by refractory shock