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Abstract:
An unconventional presentation of an elderly man with sepsis and a nonfunctioning permanent cardiac pacemaker is reviewed. Our interpretations of signs of an acute abdomen and laboratory evidence suggestive of acute cholecystitis did not lead to the correct diagnosis. The pacemaker electrode had perforated the myocardium and this event is believed to be secondary to bacterial endocarditis at the electrode tip. The therapeutic implications of this unique case are discussed.
Insights
A rare case of sepsis in an elderly man revealed a perforated pacemaker electrode, likely due to bacterial endocarditis. This highlights the importance of considering device complications in atypical presentations.
Area of Science:
- Cardiology
- Infectious Diseases
- Geriatric Medicine
Background:
- Elderly patients with sepsis can present atypically.
- Permanent cardiac pacemakers are common in elderly patients.
- Bacterial endocarditis is a known complication of indwelling devices.
Observation:
- An elderly male presented with sepsis and a nonfunctioning permanent cardiac pacemaker.
- Clinical signs of acute abdomen and laboratory results suggested acute cholecystitis.
- The initial diagnosis did not account for the pacemaker's role.
Findings:
- The permanent pacemaker electrode had perforated the myocardium.
- Bacterial endocarditis at the pacemaker electrode tip was identified as the likely cause.
- This led to an unconventional presentation of sepsis.
Implications:
- This case underscores the need to consider pacemaker complications in sepsis evaluations.
- Early recognition of device-related infections is crucial for appropriate management.
- Therapeutic strategies must address both sepsis and the cardiac device issue.