Pacemaker lead thrombo-endocarditis in an intravenous drug abuser

Abstract

We report a 30-year-old male intravenous drug abuser presenting with persistent pacemaker lead thrombosis with superimposed pacemaker lead endocarditis. He underwent urgent surgery, but expired due to refractory sepsis. This case confirms that patients with pacemakers are at risk of developing pacemaker lead thrombosis. In addition, they are at high risk of developing pacemaker lead endocarditis if additional risk factors for endocarditis are present. We believe this case report is unusual on account of pacemaker lead thrombosis as well as endocarditis occurring in a patient with history of intravenous drug abuse. Whether pacemaker patients with multiple leads need to be on long-term antiplatelet or anticoagulation therapy necessitates further studies.

Keywords: Intravenous drug abuse; Pacemaker lead endocarditis; Pacemaker lead thrombosis; Septic shock.

Figure 1

Transthoracic echocardiography (A) showing a thrombus (marked) adherent to a pacemaker lead. Computed tomography pulmonary angiogram (B) showing a large left lower pulmonary artery embolism in a patient with pacemaker lead thrombosis.

Figure 2

Multiple transthoracic echocardiographic views demonstrating large thrombotic vegetation attached to a pacemaker lead prolapsing through tricuspid valve.