A Case of Late Implantable Cardiac Device Infection with Aspergillus in an Immunocompetent Host

Abstract

Patient: Female, 67Final Diagnosis: Infected pacemaker device secondary to Aspergillus fumigatusSymptoms: Swelling over the left pectoral regionMedication: VoriconazoleClinical Procedure: Pacemaker explantationSpecialty: CardiologyObjective:Unusual clinical courseBackground:With the increasing use of cardiac implantable electronic devices (CIED), there has been an associated increase in rate of complications. Infection accounts for about 1% of these, of which only a handful were reported secondary to Aspergillus fumigatus. All of these were seen in chronically-ill patients with several co-morbid conditions within a few years of implantation. None have been reported in an otherwise immunocompetent patient at 7 years after CIED implantation.Case Report:A 67-year-old woman with symptomatic sick sinus syndrome required a pacemaker 15 years ago with subsequent revision 7 years prior due to battery depletion. She now presented with a left pectoral non-tender mass that developed over several weeks. She denied history of recent fever, trauma, or infection. An elective pacemaker revision and pocket exploration led to the drainage of 150 cc of serosanguineous discharge from the pocket. She received peri-procedural prophylaxis with Vancomycin, but later, wound cultures grew Aspergillus fumigatus. She underwent complete removal of the pacemaker system along with a 6-week course of voriconazole and is doing well.Conclusions:Even though Staphylococcus aureus causes most CIED infections, there should be a suspicion for fungal organisms, especially in culture-negative infections, in immunocompromised states like diabetes mellitus or with minimal improvement on antibiotics. If not treated appropriately, aspergillosis may have catastrophic outcomes, including endocarditis, often leading to death. Appropriate treatment should include immediate initiation of antifungals and removal of the CIED. It is still unclear why an immunocompetent patient developed aspergillosis, but appropriate management helped avoid a grave outcome.

Delayed Pacemaker Generator Pocket and Lead Primary Infection Due to Burkholderia Cepacia

“…Gram-negative bacilli, other Gram-positive cocci, multiple bacteria and fungal organisms including Aspergillus are much less common, found in 9%, 4%, 7%, and 2% of cases, respectively [ 9 – 12 ]. Non-tuberculous Mycobacteria are rarely identified as a cause of CIED infection (0.2%) [ 13 ]. B. cepacia has been reported in a case report of prosthetic valve endocarditis and a case report of pacemaker pocket infection [ 4 , 14 ].…”