A rare case of pacemaker lead endocarditis successfully treated with open heart surgery

  • Darko Boljevic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
  • Aleksandra Barac Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Petar Vukovic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
  • Dejan Kojic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
  • Milovan Bojic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
  • Jelena Micic Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Salvatore Rubino Department of Biomedical Sciences, University of Sassari, Sassari, Italy
  • Bianca Paglietti Department of Biomedical Sciences, University of Sassari, Sassari, Italy
  • Aleksandra Nikolic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
Keywords: pacemaker, endocarditis, device-related, Staphylococcus, lead infection

Abstract

Background: Cardiac device-related endocarditis has emerged as a serious complication in the era of advanced medical technology. Pacemaker related infections are rare and life-threatening with incidence from 0.06% to 7% and high mortality rate (30-35%). Diagnosis is hard, frequently delayed and could be even missed due to poor clinical findings. The average delay in diagnosis is 5.5 month. We report a case of the late-onset of pacemaker lead endocarditis caused by S. epidermidis successfully treated with open heart surgery.

Case Report: Patient with persistent high fever for 11 month and suspicion for infective endocarditis was admitted in Cardiovascular Institute. No clinical signs of endocarditis were observed. TTE revealed large vegetation 30 × 17 mm attached to the atrial electrodes with high embolic potential. This finding was verified by transesophageal echocardiography (TEE), although CT scan did not reveal vegetation. Blood cultures were negative. A sternotomy with cardiopulmonary bypass was performed and electrodes were extracted with large vegetation. Intraoperative finding revealed large thrombus with vegetation around pacemaker leads. Cultures of the electrodes and vegetation revealed Staphylococcus epidermidis. Surgery was followed up with antibiotic treatment for 6 weeks. He has been followed up for the next 2 years, and without complications.

Conclusion: The absence of criteria for endocarditis and negative blood cultures should not keep the physician from ruling out lead endocarditis. This complication carries high risk of mortality if left untreated.

Published
2019-11-30
How to Cite
1.
Boljevic D, Barac A, Vukovic P, Kojic D, Bojic M, Micic J, Rubino S, Paglietti B, Nikolic A (2019) A rare case of pacemaker lead endocarditis successfully treated with open heart surgery. J Infect Dev Ctries 13:1068-1071. doi: 10.3855/jidc.11941
Section
Case Reports