Pacemaker lead endocarditis: A rare diagnosis with a varied presentation.

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Infections

Background:

• Pacemaker lead endocarditis is a serious complication of cardiac electronic device implantation.
• Diagnosis can be challenging, especially in cases without obvious signs of local infection.
• Late-onset infections pose a diagnostic dilemma.

Purpose of the Study:

• To highlight the importance of considering pacemaker lead endocarditis in patients with unexplained fever and infection parameters.
• To emphasize the diagnostic limitations of transthoracic echocardiography for this condition.
• To underscore the necessity of transesophageal echocardiography for definitive diagnosis.

Main Methods:

• Case presentation of a patient with pacemaker lead endocarditis.
• Review of diagnostic approaches for pacemaker-related infections.
• Comparison of transthoracic echocardiography and transesophageal echocardiography sensitivity.

Main Results:

• The patient presented with fever and laboratory signs of infection but no pocket infection.
• Transthoracic echocardiography was insufficient for diagnosis.
• Transesophageal echocardiography confirmed pacemaker lead endocarditis.

Conclusions:

• Pacemaker lead endocarditis should be suspected in any patient with a pacemaker presenting with fever and infection markers, regardless of implantation time.
• Transesophageal echocardiography is the gold standard for diagnosing pacemaker lead endocarditis.
• Early consideration and appropriate imaging are crucial for timely diagnosis and management.