False positive result of positron emission tomography in a patient with suspected defibrillator system infection

The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron emission tomography-computerized tomography (PET-CT) has recently been shown to be of great interest in this difficult clinical setting. We report the case of a patient with suspected implantable cardioverter-defibrillator (ICD) infection. Because of ¹⁸F-fluorodeoxyglucose (FDG) uptakes on different portions of the ICD, complete extraction of the ICD generator and lead was performed. Bacteriological samples remained sterile. FDG PET-CT, which appears to be a promising tool for the management of patients with suspected pacemaker/ICD infection, does not have a perfect specificity to detect lead infection, and should not be used alone to diagnose difficult cases of implantable cardiac device infection. The aim of this case is to bring to light the necessity of specifying the place of PET-CT and its limits for the diagnosis of endocarditis on pacemaker/ICD devices.>.