title: Gram-positive occult bacteremia in patients with pacemaker and mechanical valve prosthesis: a difficult therapeutic challenge.
abstract: OBJECTIVE
  In pacemaker patients with Gram-positive occult bacteremia, it is reasonable to remove the whole stimulation system, but therapeutic decision is sometimes very challenging.
  
  
  RESULTS
  A young patient at 6 years of age underwent dual-chamber pacemaker implantation due to complete atrioventricular block after mitral valve replacement. He felt well until November 2008, when he suffered from febrile illness with blood cultures disclosing methicillin-resistant staphylococcus aureus strain. Repeated antibiotic courses were effective only in obtaining temporary remissions. Consecutive transoesophageal echocardiography examinations were inconclusive. A labelled leucocyte scintigraphy, showing increased captation along leads, was very helpful and critical in guiding our decision to extract leads.
  
  
  CONCLUSIONS
  In equivocal cases, or when the hazard of extraction procedure is presumably high, every accessory diagnostic tool (like scintigraphy with labelled leucocytes) is helpful in establishing a definitive diagnosis and in strengthening a somewhat difficult decision.
authors.affiliation: Department of Internal Medicine, University Cardiology, San Giovanni Battista Hospital, University of Turin, Turin, Italy. pg.golzio@gmail.com
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Golzio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Gabbarini
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Melissa
authors.initials: M
authors.lastname: Vinci
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D002648:Child; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000382:microbiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents