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Case Reports
. 2024 Nov 1;10(21):e40073.
doi: 10.1016/j.heliyon.2024.e40073. eCollection 2024 Nov 15.

Intractable late onset pacemaker endocarditis and complications case report

Gaelle Ghazal  1 , Michel Boueiz  1 , Georgio El Koubayati  1 , Majd Khalil  2 , Ziad Mansour  3 , Nabil Khoury  2
Affiliations
Case Reports

Intractable late onset pacemaker endocarditis and complications case report

Gaelle Ghazal et al. Heliyon. .

Abstract

Background: Cardiac implantable electronic devices (CIEDs), including pacemakers, have undeniably revolutionized the treatment of cardiac conditions. However, just like any other treatment or intervention some significant challenges can be encountered in CIEDs, mainly, CIED infections. With reported incidence rates ranging from 1 % to 15 % these infections can pose lead to dangerous complications. Our case report presents an occurrence of late-onset pacemaker endocarditis, which despite proper antibiotic therapy required an open-heart surgery as the only curative option.

Case presentation: Our patient is a 50-year-old female known to have a pacemaker implanted twenty years ago, she presented with fever and purulent discharge from her pacemaker site. After thorough investigations, diagnostic tests confirmed a Serratia marcescens infection and despite antibiotic treatment, the patient's symptoms persisted, an echocardiography revealed tricuspid valve involvement with vegetations. Surgical intervention, by complete removal of the old and new pacemaker leads, tricuspid valvuloplasty, and installation of an epicardial pacemaker, was performed.

Conclusion: Our case highlights the rarity and complexity of Serratia marcescens-related pacemaker endocarditis and all CIEDs in general, while emphasizing the importance of interdisciplinary management to optimize patient outcomes. Early diagnosis, prompt treatment, and comprehensive surgical approaches are essential in managing CIED infections and achieving successful outcomes.

Keywords: CIED infections; Cardiac implantable electronic devices; Case report; Endocarditis; Epicardial pacemaker; Interdisciplinary management; Pacemakers; Serratia marcescens; Surgical intervention; Tricuspid valve.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Georgio EL KOUBAYATI reports was provided by Lebanese University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Timeline of past medical history and interventions.
Fig. 2
Fig. 2
Chest X-ray showing the new left sided pacemaker and leads as well as the old right side pacemaker leads.
Fig. 3
Fig. 3
TEE showing the vegetations on the pacemaker lead and TV.
Fig. 4
Fig. 4
Image of the vegetations on the tricuspid valve of the patient.
See this image and copyright information in PMC

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