A case report of pacemaker endocarditis presenting as osteitis in a high surgical risk patient: A management challenge with thromboaspiration and leadless pacemaker implantation

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ID: 322971
2026
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Abstract
Abstract Background Cardiac implantable electronic device-related infective endocarditis is a serious and increasingly frequent complication, often presenting atypically in frail patients with multiple comorbidities. Case Summary We report the case of an 83-year-old man admitted with fever and heel pain, who developed heart failure symptoms. Investigations revealed Staphylococcus aureus bacteremia, osteitis, spondylodiscitis, and a large tricuspid valve vegetation (26 mm) attached to the pacemaker lead, complicated by pulmonary embolism. Given his high surgical risk and resistant Gram-positive bacteremia, a multidisciplinary endocarditis team opted for percutaneous vegetation thromboaspiration, complete device extraction, and pacing was ensured via an externalized temporary-permanent pacing system. After infection clearance, a leadless pacemaker was successfully implanted. The clinical outcome was favorable, with no recurrence or complications on follow-up. Conclusion This case emphasizes the importance of early suspicion, advanced imaging, and tailored management of CIED-related endocarditis. Leadless pacemakers and percutaneous aspiration represent valuable strategies in high-risk patients to reduce infection recurrence and embolic risk.
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Authors Wassim Beladel, Zakaria Chaib, Caroline Birgy, Isabelle Lecardonnel, Mohamed El Minaoui
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag576
URL
https://doi.org/10.1093/ehjcr/ytag576
Keywords Keywords not found

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