Infective Endocarditis due to Esophageal Squamous Cell Carcinoma Invasion of the Left Atrium - A Case Report

Sep 30, 2026

Report a rare clinical case in which esophageal squamous cell carcinoma directly invaded the left atrium during chemotherapy, subsequently complicated by infective endocarditis. A 52-year-old woman presented with chest/back pain and progressive dysphagia, received chemotherapy and chemoradiotherapy, then developed high fever with seizures and loss of consciousness during second-line chemoimmunotherapy. Echocardiography showed a mobile left atrial mass; emergency surgery removed an invading tumor and septic thrombus. Despite source removal, infection control remained difficult and the patient died of sepsis on POD 56.

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CategoryHealthcare

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Abstract

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SURGICAL CASE REPORTS Surg Case Rep 2026; 12: 25-0568 Case Report Infective Endocarditis due to Esophageal Squamous Cell Carcinoma Invasion of the Left Atrium: A Case Report Takeru Nakamura,1 Ikuko Shibasaki ,1 Masanobu Nakajima,2 Kazuyuki Ishida,3 Masatoshi Nakagawa,2 Kazuyuki Kojima,2 and Hirotsugu Fukuda1 ABSTRACT INTRODUCTION: Esophageal cancer is often diagnosed at an advanced stage and with distant metastases. While cardiac metastases from solid tumors have been reported in 0.2%–6 . 5% of postmortem cases, solitary cardiac metastases remain exceedingly rare. Infective endocarditis, alife-threatening condition typically associated with valvular involvement and bacteremia, has not been widely associated with cardiac metastases. Here, we present an extremely rare case of esophageal squamous cell carcinoma directly invading the left atrium during chemotherapy, which was further complicated by infective endocarditis. CASE PRESENTATION: A 52-year-old female who presented with chest and back pain and progressive dysphagia was diagnosed with esophageal squamous cell carcinoma following an endoscopic biopsy. Chemotherapy and chemoradiotherapy resulted in inadequate tumor control. During the second course of second-line chemoimmunotherapy, the patient developed a high fever, followed by seizures and loss of consciousness, and required emergency intubation. Echocardiography revealed a mobile mass 5 × 30 mm in size attached to the posterior wall of the left atrium. To prevent further embolic complications, emergency surgery was performed, which revealed a tumor invading the left atrial wall. Histopathological findings revealed a necrotic mass containing keratinizing squamous cell carcinoma fragments and a septic thrombus, consistent with infective endocarditis originating from the tumor surface. The patient did not regain consciousness following surgery, possibly because of hypoxic–ischemic brain injury following seizure-induced hypoxemia. Infection control remained poor, and the patient died of sepsis on POD 56. CONCLUSIONS: Direct invasion of the left atrium by esophageal squamous cell carcinoma is rare, and infective endocarditis arising from tumor surfaces within the cardiac chamber is exceptionally uncommon, particularly in immunosuppressed patients. In this case, surgery was performed to prevent further embolic events and remove the infected tumor mass. Although the direct source of the infection was surgically removed, infection control remained difficult, likely due to persistent infection under immunosuppressive conditions and the use of cardiopulmonary bypass. This case highlights the challenges of managing infective endocarditis in patients with cancer and suggests that early surgical intervention may help reduce embolic risk, even when complete infection control cannot be achieved. KEYWORDS: esophageal squamous cell carcinoma, infective endocarditis, direct invasion of the left atrium, cardiac involvement 1Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan 2Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan 3Department of Diagnostic Pathology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan Corresponding author: Ikuko Shibasaki. Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan E-mail: [ikushiba726@gmail.com](ikushiba726@gmail.com) Received: September 10, 2025; Accepted: November 27, 2025 DOI: 10.70352/scrj.cr.25-0568 Supplementary materials are available online. © 2026 The Author(s) . Published by Japan Surgical Society This article is licensed under a Creative Commons Attribution 4.0 International License. Nakamura T. et al. Abbreviations AC adenocarcinoma CF-PEM cisplatin, 5-fluorouracil, plus pembrolizumab CPB cardiopulmonary bypas

FAQs

Why is this case considered exceptionally rare?

Direct invasion of the left atrium by esophageal squamous cell carcinoma is rare, and infective endocarditis arising from tumor surfaces within the cardiac chamber is exceptionally uncommon, especially in immunosuppressed patients.

What symptoms and diagnostic findings were reported before treatment?

The patient presented with chest and back pain and progressive dysphagia. Endoscopic biopsy confirmed esophageal squamous cell carcinoma, and echocardiography later revealed a mobile mass attached to the posterior wall of the left atrium.

What complications occurred during second-line chemoimmunotherapy?

A high fever developed, followed by seizures and loss of consciousness, necessitating emergency intubation. A septic thrombus consistent with infective endocarditis was found associated with the tumor.

What was the outcome after emergency surgery?

Surgery removed the tumor invading the left atrial wall and the infected material, but infection control remained difficult, and the patient died of sepsis on POD 56.

Sep 30, 2026

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