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Published on: February 28, 2012
[Spondylodiscitis disclosing endocarditis on the endocavitary electrodes of cardiac pacemakers]
J Bonal1, C Bouchiat, J P de Jaureguiberry
1Service de médecine interne, hôpital d'instruction des armées Sainte-Anne, Toulon Naval.
Abstract:
Permanent pacemaker electrode infection is rare but can be fatal. The authors report two cases presenting with spondylodiscitis, a previously described mode of presentation of valve endocarditis but not previously reported in this context. In one case, recurrent courses of antibiotics did not prevent repeated episodes of bacteraemia. In the second, the relapse of infection occurred at different sites of the vertebral column until surgical removal of the electrodes: the usual features of this pathology were observed: frequent but not constant infection at the site of the pacemaker implantation, making the diagnosis more difficult; delayed signs of spondylodiscitis after implantation of the pacemaker; recurrence of infection when antibiotic therapy alone was prescribed and, therefore, the need for surgical ablation of all implanted material. The authors underline the diagnostic value of transoesophageal echocardiography.
Insights
Permanent pacemaker electrode infections can lead to fatal spondylodiscitis. Surgical removal of infected pacemaker leads is crucial, as antibiotics alone may not suffice, and transoesophageal echocardiography aids diagnosis.
Area of Science:
- Cardiology
- Infectious Diseases
- Neurosurgery
Background:
- Permanent pacemaker implantation is a common procedure.
- Pacemaker electrode infections are rare but serious complications.
- Spondylodiscitis is a potential, though infrequently reported, manifestation of pacemaker lead infection.
Observation:
- Two cases of permanent pacemaker electrode infection presenting with spondylodiscitis are described.
- Infection at the pacemaker implantation site was not consistently present, complicating diagnosis.
- Delayed onset of spondylodiscitis symptoms after pacemaker implantation was noted.
Findings:
- Recurrent bacteraemia occurred despite multiple antibiotic courses in one patient.
- Relapsing vertebral infection at multiple sites necessitated surgical removal of pacemaker electrodes.
- Transoesophageal echocardiography proved valuable in diagnosing the extent of infection.
Implications:
- Surgical ablation of all implanted material is often required for definitive treatment.
- Early and accurate diagnosis, potentially aided by transoesophageal echocardiography, is critical.
- This presentation highlights a rare but severe complication of permanent pacemaker use.
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