2024 Volume 53 Issue 6 Pages 324-328
The case was a 70-year-old man. Nine years after VVI pacemaker implantation with a screw-in electrode, the battery was replaced. One year later, a new electrode was added due to pacing failure, and the old electrode was left in the pocket with silicone cap. Two months later, he was admitted due to fever. Although no infection was recognized, an increase in pericardial effusion was observed and the patient, with a past history of interstitial pneumonia, was positive for anti-ARS antibodies. Therefore, colchicine and aspirin were administered as nonspecific pericarditis, and the pericardial effusion disappeared in 2 weeks. When the dose of aspirin was reduced two months later, the inflammatory reaction flared-up. CT scan showed an abscess between the liver and the right ventricular wall. The electrode, penetrated the right ventricle, was continuous into the abscess cavity. During open heart surgery, it was observed the old electrode firmly adhered to the superior vena cava, right atrium, tricuspid valve, and anterior papillary muscle and successfully dissected and removed without bleeding. The chest was closed after aggressive lavage of the abscess cavity and the pocket. Fluid retention was observed in the pocket, the old electrode internal lumen, and the abscess cavity. Cutibacterium was detected in all of them. It was thought that Cutibacterium pocket infection was transmitted through the internal lumen of the screw-in electrode that penetrated the right ventricular wall and caused intrapericardial abscess. There were no reports about infection transmitted route as in this case.
