Extensive myocardial calcification following cytokine release syndrome and sepsis: a novel case report with advanced echocardiographic assessment.

Background: Myocardial calcification is a rare complication, typically associated with chronic myocardial injury or severe metabolic disturbances. Rapid development in the setting of cytokine release syndrome (CRS) and sepsis is exceptional and, to our knowledge, has not been previously reported. Case summary: We describe a 44-year-old man with acute myeloid leukaemia who developed CRS and subsequent septic shock, requiring high-dose vasopressor support and continuous renal replacement therapy. On day 70 of hospitalization, a computed tomography scan revealed extensive intramyocardial calcification of the left ventricle. Serial transthoracic echocardiography demonstrated progressive systolic dysfunction, with global longitudinal strain deteriorating from -22% to -9%, and a markedly reduced global work index (GWI 780 mmHg%), indicating impaired intrinsic contractility. Global work efficiency (GWE 96%) remained preserved. Discussion: This is the first reported case of rapidly progressive myocardial calcification associated with CRS, documented using advanced non-invasive imaging modalities such as GLS and myocardial work. These techniques enabled early detection and objective assessment of functional decline in a critically ill patient, in whom conventional diagnostic options were limited.