PT  - JOURNAL ARTICLE
AU  - Fotini C. Ampatzidou
AU  - Maria N. Sileli
AU  - Charilaos-Panagiotis C. Koutsogiannidis
AU  - Olga G. Ananiadou
AU  - Athanasios A. Madesis
AU  - Vassilis G. Michaelidis
AU  - George E. Drossos
TI  - Atypical pattern of lung involvement in pacemaker endocarditis
AID  - 10.4187/respcare.02907
DP  - 2013 Nov 05
TA  - Respiratory Care
PG  - respcare.02907
4099  - http://rc.rcjournal.com/content/early/2013/11/05/respcare.02907.short
4100  - http://rc.rcjournal.com/content/early/2013/11/05/respcare.02907.full
AB  - Pacemaker endocarditis has a high rate of morbidity and mortality and is associated with substantial healthcare cost. To maximize the effectiveness of treatment, diagnosis of pacemaker endocarditis should be made as early as possible. Medical treatment alone is not successful and the removal of the entire artificial pacing system is often required. We present a case of a female patient with permanent transvenous pacemaker, recurring episodes of fever, chills, general malaise and a computed tomograph image of a solitary, tumor-like lesion indicating pneumonia. The symptoms subsided with empirical antibiotics but without improvement in the radiologic images. A wedge resection of the lesion by thoracotomy was performed revealing a necrotic lung lesion compatible with pulmonary infarct. Transesophageal echocardiography showed a mass that was adherent to the pacemaker lead. The therapeutic approach consisted of surgical removal of the complete pacing system along with long term antibiotic therapy and implantation of a new device with epicardial lead. Serial follow-up echocardiograms for one year period did not show any recurrence and the subsequent course was uneventful.