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Pacemaker infection with propionibacterium and a nephritic sediment.
M Kimmel1, U Kuhlmann, D M Alscher
1Department of General Internal Medicine and Nephrology, Robert Bosch Hospital, Stuttgart, Germany. vm.kimmel@t-online.de
Clinical Nephrology
|January 26, 2008
Summary
Propionibacterium pacemaker infections, though rare, can cause serious kidney issues like glomerulonephritis. Prompt diagnosis and antibiotic treatment are crucial for recovery, even with unusual bacterial culprits.
Area of Science:
- Cardiology
- Nephrology
- Infectious Diseases
Background:
- Pacemaker infections are known complications of implanted cardiac devices.
- Staphylococcus species are the most common pathogens, while Propionibacterium is rarely implicated (1%).
- Infections can lead to systemic complications, including kidney disease.
Observation:
- A young female patient with a pacemaker presented with nephritic sediment and hypocomplementemia.
- Initial blood cultures positive for Propionibacterium were dismissed as contamination.
- Transesophageal ultrasound revealed a vegetation on a pacemaker lead.
Findings:
- Despite initial skepticism, persistent positive blood cultures confirmed Propionibacterium infection.
- Treatment with clindamycin resolved the infection, normalizing complement levels and blood cultures.
- Immune complex glomerulonephritis was diagnosed secondary to the pacemaker infection.
Implications:
- This case highlights the importance of considering rare pathogens in pacemaker infections.
- Propionibacterium pacemaker infections can lead to significant renal complications like glomerulonephritis.
- Prompt diagnosis and treatment are essential to prevent severe outcomes and avoid unnecessary procedures like renal biopsy.
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