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
SARS-CoV-2/COVID-19
22 February 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938732
22 February 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938761
16 March 2023 : Case report
Am J Case Rep 2023; 24:e938359
01 March 2023 : Case report
Am J Case Rep 2023; 24:e937955
In Press
17 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939411
17 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939474
16 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938752
15 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938875
Most Viewed Current Articles
13 Jul 2022 : Case report
DOI :10.12659/AJCR.936441
Am J Case Rep 2022; 23:e936441
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
07 Dec 2021 : Case report
DOI :10.12659/AJCR.934347
Am J Case Rep 2021; 22:e934347