A case of permanent pacemaker lead infection.
BACKGROUND
A 70-year-old man with diabetes mellitus, fever of unknown origin and oliguria was admitted to hospital. Blood cultures were positive for a Staphylococcus aureus infection and antibiotic therapy was started. A year previously the patient had received a DDD pacemaker to treat sick sinus syndrome with intermittent atrioventricular block. Transthoracic echocardiography showed severe tricuspid regurgitation and a mass attached to the ventricular pacemaker lead; transesophageal echocardiography showed the same finding but additionally showed a vegetation on the tricuspid septal leaflet and a mass attached to the atrial pacemaker lead. Coronary angiography revealed a lesion that occluded 70% of the proximal left anterior descending artery and occlusion of the proximal right coronary artery.


METHODS
Electrocardiography, transthoracic echocardiography, transesophageal echocardiography, multidetector thoracic CT, coronary angiography, blood cultures and laboratory testing.


METHODS
Pacemaker lead infection and tricuspid valve endocarditis.


RESULTS
The patient was surgically treated under cardiopulmonary bypass during which the pacemaker system was removed and an accurate debridement of the tricuspid tissue was performed.
Simon
Caterina
C
Department of Cardiac Surgery, Saint Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
Capuano
Fabio
F
Roscitano
Antonino
A
Sinatra
Riccardo
R
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D003646:Debridement; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000382:microbiology* / Q000473:pathology
D000900:Anti-Bacterial Agents