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

Darko Boljevic; Aleksandra Barac; Petar Vukovic; Dejan Kojic; Milovan  Bojic; Jelena Micic; Salvatore Rubino; Bianca Paglietti; Aleksandra Nikolic

doi:10.3855/jidc.11941

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

Authors

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

DOI:

https://doi.org/10.3855/jidc.11941

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.

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Published

2019-11-30

How to Cite

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

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Issue

Vol. 13 No. 11: November 2019

Section

Case Reports

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