ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case

Abstract

Introduction. Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections, and pocket-site infections, primarily involving Staphylococcus species. Infective endocarditis is a rare but life-threatening complication of gonococcal bacteremia. We report the first case of a CIED pocket-site infection secondary to Neisseria gonorrhoeae (N. gonorrhoeae). Case. A 56-year-old male with a history of congestive heart failure status postimplantable cardioverter-defibrillator (ICD) insertion presented with a pocket-site swelling initially concerning for a hematoma which began to exhibit erythema and tenderness. The patient reported a history of high-risk sexual behavior. On presentation, he was afebrile and hemodynamically stable. Physical exam showed a 5 cm × 6 cm pocket-site swelling with overlying erythema. Labs revealed elevated ESR and CRP levels. Transthoracic and transesophageal echocardiography was concerning for infective endocarditis and lead vegetations. Blood cultures tested positive for N. gonorrhoeae. He underwent surgical debridement with complete ICD extraction and drainage of infected serosanguineous pocket fluid. Tissue cultures were negative, but isolation of N. gonorrhoeae in blood cultures confirmed it as the causative agent of the pocket-site infection in the absence of prior Gram-positive coverage. He was started on a prolonged course of ceftriaxone for 4 weeks with reimplantation of ICD at a different site after completion of treatment. Conclusion. In patients with high-risk sexual behavior, gonococcal bacteremia can potentially lead to CIED infection. These individuals should be prudently evaluated for infective endocarditis or pocket-site infections as presenting complaints can be subtle.

Defibrillator-associated gonococcal endocarditis

“…Neisseria gonorrhea endocarditis is a rare complication of DGI and represents less than 0.1% of such cases. 1 , 2 , 3 Although CIED pocket infection has been reported in DGI, 4 to our knowledge this is the first report of CIED-associated gonococcal endocarditis. Acute and subacute CIED infections are typically attributed to coagulase-negative Staphylococcus, whereas chronic infections are largely caused by S. aureus (50%) and coagulase-negative staphylococci (50%) in more than 95% of cases.…”

Disseminated Gonococcal Infection Due to a Mediport Catheter Infection

“…An estimated 1-2% of patients with DGI can develop endocarditis and, in rare cases, may be the sole manifestation of DGI. In addition, there has been a case of a cardiovascular implantable electronic device infection with associated bacteremia due to N. gonorrhoeae [ 12 ]. From our review of PubMed and Google Scholar, there are no other reported cases of mediport or other central venous catheter infections due to N. gonorrhoeae .…”