Pacemaker lead endocarditis: A rare cause of relapsing brucellosis

Abstract

Implantable cardioverter-defibrillator endocarditis is a rare and potentially life threatening complication of brucellosis of difficult management for clinicians. We report an unusual case of pacemaker-related endocarditis due to Brucella melitensis in a patient with previous history of neurobrucellosis. Our patient was admitted to a hospital with severe swelling of his pacemaker pocket implanted 8 years earlier for sick sinus syndrome. Although pocket site cultures were positive for Brucella but blood cultures were not and serologic titer by the Rose Bengal test was positive. Transesophageal echocardiography showed two vegetations on the pacemaker leads. The patient was treated with doxycycline, rifampin and gentamicin with full recovery and the entire pacemaker apparatus was surgically explanted. Interestingly, two year prior this admission, the patient presented with meningoencephalitis diagnosed with neurobrucellosis proven by positive growth of Brucella mellitensis from the CSF. The patient was treated with doxycycline, rifampin and gentamicin with full recovery and the pacemaker had been removed. Reports of Brucella infection of prosthetic implants and devices have increased over the past decade. Consequently, potential relapsing of the disease and occupational exposure to Brucella should be considered in the differential diagnosis and management of cardiac device infection.

Keywords: Brucella melitensis; Neurobrucellosis; Pacemaker induced endocarditis; Relapsing brucellosis; Sick sinus syndrome.

Fig. 1

Vegetations on pacemaker lead. Transthoracic echocardiography, parasternal long axis view showing a large vegetation in the pacemaker lead in a case of brucella infective endocarditis (A). 3D transesophageal echocardiography showing a pedunculated echodense mass in a portion of the lead (B). RA, right atrium. RV, right ventricle.