Polymicrobial Cardiac Implantable Electronic Device Endocarditis in a Patient With Device Expulsion

Cardiac implantable electronic device (CIED) lead erosion and device expulsion are rare complications that are associated with significant morbidity and mortality. We describe the case of a 74-year-old man who presented with fever, chills, and night sweats after spontaneous implantable cardiac defibrillator expulsion over a decade after its implantation. A transthoracic echocardiogram revealed a large intracardiac vegetation, and a combination of blood and hardware cultures identified Staphylococcus hominis, Corynebacterium striatum, and Citrobacter koseri. Management involved percutaneous vegetation removal, device extraction, pocket debridement, and a prolonged course of targeted antibiotics. This case highlights the potential for very late device erosion and subsequent endocarditis, via either direct microbial seeding of intracardiac structures, hematogenous spread from the pocket infection, or both. It underscores the importance of early recognition, blood and device cultures, and timely device extraction in managing CIED-related infections.