01 March 2018 : Case report
Intracardiac Abscess and Pacemaker Lead Infection Secondary to Hematogenous Dissemination of Methicillin-Sensitive Staphylococcus Aureus from a Prior Diabetic Foot Ulcer and Osteomyelitis
Rare disease
Kristopher S. Pfirman1ABCDEF*, Robel Haile2ACDDOI: 10.12659/AJCR.906227
Am J Case Rep 2018; 19:224-228
Abstract
BACKGROUND: Intracardiac abscesses are an unusual occurrence in developed countries. With the increase in use of implantable cardiac devices, the increase use of and advancements in antibiotics, and the longevity of patients with cardiac devices, one may expect an increase in such infections; however, case reports are rare. We are presenting a case in which hematogenous dissemination of methicillin-sensitive Staphylococcus aureus (MSSA) infection from a lower extremity diabetic ulcer propagated into an infected pacemaker lead and ultimately an intracardiac abscess of the right atrium.
CASE REPORT: A 77-year-old male with a history of MSSA diabetic foot infection complicated by osteomyelitis presented with fever, syncope, and wide complex tachycardia, and he was found to have an intracardiac abscess and fibrinous lead vegetations. The patient was deemed too ill for invasive surgical intervention given his comorbidities, pacemaker generator replacement requirement, and intermittent ventricular tachycardia. The patient was subsequently sent home with oral antibiotics and home hospice per patient and family wishes.
CONCLUSIONS: This case demonstrated how hematogenous dissemination of MSSA infections from a diabetic foot ulcer and osteomyelitis can seed pacemaker hardware resulting in an intracardiac abscess. Unfortunately, our patient was too ill to undergo all procedures required to eradicate the abscess and infected pacemaker hardware. The standard of care would be complete hardware removal. Conservative management would include indefinite or prolonged antibiotic therapy, with the notion that intracardiac abscesses cannot be cured with antibiotics alone. This conservative management approach would be deemed necessary in a select population that cannot undergo surgical intervention.
Keywords: Abscess, Endocarditis, Bacterial, Pacemaker, Artificial, Staphylococcus aureus
In Press
Case report
Takotsubo Syndrome-Induced Cardiogenic Shock in Lung Transplantation: Importance of Early Diagnosis and ECM...Am J Case Rep In Press; DOI: 10.12659/AJCR.944942
Case report
Priapism Following Coronary Angiography: A Case Report and Clinical Insights for Diagnosis and ManagementAm J Case Rep In Press; DOI: 10.12659/AJCR.943609
Case report
Anterior Mitral Line Ablation-Induced Complete Heart Block: A Cautionary Case StudyAm J Case Rep In Press; DOI: 10.12659/AJCR.945818
Case report
Dual-Plate Fixation in Treatment of Clavicle Fractures in Dementia Patients: A Case SeriesAm J Case Rep In Press; DOI: 10.12659/AJCR.945489
Most Viewed Current Articles
21 Jun 2024 : Case report 72,630
Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report 44,111
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report 32,596
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
23 Feb 2022 : Case report 20,506
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250