Pacemaker lead endocarditis: A rare cause of relapsing brucellosis

Area of Science:

• Infectious Diseases
• Cardiology
• Medical Case Reports

Background:

• Implantable cardioverter-defibrillator endocarditis is a rare complication of brucellosis.
• Brucella infections of prosthetic devices are increasingly reported.
• Neurobrucellosis can precede or coexist with cardiac device infections.

Purpose of the Study:

• To report an unusual case of pacemaker-related endocarditis caused by Brucella melitensis.
• To highlight the diagnostic challenges and management strategies for Brucella endocarditis.
• To emphasize the importance of considering Brucella in cardiac device infections, especially with a history of neurobrucellosis.

Main Methods:

• Case report of a patient with a pacemaker and a history of neurobrucellosis.
• Diagnosis involved pocket site cultures, serologic testing (Rose Bengal test), and transesophageal echocardiography.
• Treatment included a combination antibiotic regimen (doxycycline, rifampin, gentamicin) and surgical explantation of the pacemaker.

Main Results:

• Brucella melitensis was identified from pacemaker pocket site cultures.
• Transesophageal echocardiography revealed vegetations on pacemaker leads.
• The patient recovered fully after antibiotic treatment and surgical removal of the infected device.
• A prior episode of neurobrucellosis in the same patient was noted.

Conclusions:

• Brucellosis poses a significant risk for endocarditis in patients with cardiac implantable electronic devices.
• Prompt diagnosis and aggressive treatment, including device explantation, are essential for successful management.
• Clinicians should consider Brucella infection in the differential diagnosis of cardiac device endocarditis, particularly in patients with a history of brucellosis or occupational exposure.