Pacemaker infection with propionibacterium and a nephritic sediment.
Like any other implanted foreign body, the different parts of pacemakers (pulse generator pocket, epicardial or transvenous leads) can become infected. Staphylococcus aureus and coagulase-negative staphylococci are the causative organisms in most of the cases (65 â 75%), propionibacterium is described to be involved in only 1% of cases. This report describes a case of nephritic sediment in a young female patient with a pacemaker implantation 9 years ago because of a third degree atrioventricular block, in which a battery exchange was necessary 2.5 years ago. This young patient was referred from a nephrologist for renal biopsy because of a nephritic sediment and diffuse complaints including low-grade fever with a suspected underlying autoimmune disease. The laboratory examinations were all negative with the exception of a diminished C3 complement level. Blood cultures were positive for propionibacterium, but the microbiologists were considering it as a contamination. 11 more blood cultures collected thereafter were all positive and a transesophageal ultrasound revealed a small vegetation at 1 of the transvenous electrodes of the pacemaker. Because of a penicillin allergy she was treated with clindamycin, and the blood cultures were negative after a few days. After a full course (7 weeks) of antibiotic treatment the C3 complement level normalized and a series of 10 blood cultures remained negative 10 â 15 days after discontinuation of antibiotic therapy. Discussing all the differential diagnoses of a nephritic sediment combined with hypocomplementemia, positive blood cultures and a vegetation on a pacemaker electrode in the transesophageal ultrasound, the diagnosis of an immune complex glomerulonephritis due to a propionibacterium pacemaker infection needs no confirmation by renal biopsy.
Kimmel
M
M
Department of General Internal Medicine and Nephrology, Robert Bosch Hospital, Stuttgart, Germany. vm.kimmel@t-online.de
Kuhlmann
U
U
Alscher
D M
DM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D009393:Nephritis / Q000150:complications* / Q000188:drug therapy; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011424:Propionibacterium / Q000302:isolation & purification*; D016459:Prosthesis-Related Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents