Group B Streptococcus (GBS) is the leading cause of sepsis, pneumonia, and/or meningitis in neonates. Insertion of an umbilical catheter (UC) is a common practice in neonatal intensive care for primary central vascular access in extreme premature neonates. UC is used for the administration of intravenous medications, parenteral nutrition, blood samplings, and continuous central blood pressure monitoring. Malposition or migration of UC tends to occur in extreme premature infants with risks of multiple complications. We present a case of an extreme premature neonate who developed fatal GBS sepsis with autopsy findings of multiple cardiac abscesses in the myocardium but not in any other organ. GBS sepsis with isolated multifocal myocardial abscesses leading to sudden fatal clinical deterioration has not been described previously. In this review, we describe the plausible pathological mechanism of this rare presentation. Intracardiac migrated UC, in conjunction with rhythmic heart contractions and intracardiac blood flow dynamics, can cause direct trauma to the endocardium. Damaged endocardium can be a potential nidus for bacterial overgrowth and abscess formation that ultimately may lead to cardiac failure. Therefore, the correct aseptic technique of securing and management of UC, and daily assessment of UC position are recommended to prevent complications associated with catheter migration.

T.J. was involved in diagnosing, patient care, obtaining IRB approval, literature review, writing first draft of the manuscript, and approval of the final manuscript as submitted.

M.H. was involved in literature review, critical review, manuscript revision, editing the manuscript, editing radiographic images, and approval of the final manuscript as submitted.

J.Z. was involved in literature review, histopathologic exam, editing histopathologic slide pictures, critical review, and approval of the final manuscript as submitted.

F.M. was involved in literature review, histopathologic exam, and approval of the final manuscript as submitted.

M.P. was involved in diagnosing, patient care, literature review, critical review, obtaining IRB approval, manuscript revision, editing manuscript, and approval of the final manuscript as submitted.

The case report study, which included radiographic images and histopathologic slides, has received IRB approval from the University of Tennessee Health Science Center to conduct the study. Patient's personal information was de-identified in the manuscript article, radiographic images, and histopathologic slides.

Received: 11 March 2025

Accepted: 09 November 2025

Accepted Manuscript online:
12 December 2025

Article published online:
15 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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