Tamponade Hemopericardium due to Mitral Annulus Abscess Rupture

We present the case of a 71-year-old diabetic woman, suffering from chronic renal failure and with a history of hemodialysis for 6 years, who suddenly died. The autopsy showed a tamponade hemopericardium and a perforation of the left atrio-ventricular wall by an abscess of the mitral annulus. A severe picture of calcification of the mitral annulus calcification also emerged. Histology confirmed the abscess, highlighting the presence of peri-abscess endocarditis. Post-mortem microbiological investigations identified the presence of <i>Staphylococcus epidermidis</i>. The case was considered of interest, since the onset of an abscess of the mitral annulus is an infrequent occurrence and it is an even rarer event if it occurs on native heart valves and in the absence of associated finding of valve vegetation. Finally, the lethal evolution can also be considered rare since although theoretically the cardiac rupture from an abscess is a possible event that leads to death, to date no case has yet been reported.