Tsyba Evgenia, Gallego-Colon Enrique, Daum Aner Zeev, Fishman Evgeny, Chaim Yosefy
Infectious Disease Unit, Barzilai University Medical Center, Ashkelon, Israel.
Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel.
IDCases. 2018 Aug 2;13:e00431. doi: 10.1016/j.idcr.2018.e00431. eCollection 2018.
Implantable cardioverter-defibrillator endocarditis is a rare and potentially life threatening complication of brucellosis of difficult management for clinicians. We report an unusual case of pacemaker-related endocarditis due to in a patient with previous history of neurobrucellosis. Our patient was admitted to a hospital with severe swelling of his pacemaker pocket implanted 8 years earlier for sick sinus syndrome. Although pocket site cultures were positive for but blood cultures were not and serologic titer by the Rose Bengal test was positive. Transesophageal echocardiography showed two vegetations on the pacemaker leads. The patient was treated with doxycycline, rifampin and gentamicin with full recovery and the entire pacemaker apparatus was surgically explanted. Interestingly, two year prior this admission, the patient presented with meningoencephalitis diagnosed with neurobrucellosis proven by positive growth of from the CSF. The patient was treated with doxycycline, rifampin and gentamicin with full recovery and the pacemaker had been removed. Reports of infection of prosthetic implants and devices have increased over the past decade. Consequently, potential relapsing of the disease and occupational exposure to should be considered in the differential diagnosis and management of cardiac device infection.
植入式心脏复律除颤器心内膜炎是布鲁氏菌病一种罕见且可能危及生命的并发症，临床医生对此难以处理。我们报告一例因[未提及具体病菌名称]导致的与起搏器相关的心内膜炎的不寻常病例，该患者既往有神经型布鲁氏菌病病史。我们的患者因8年前因病态窦房结综合征植入的起搏器囊袋严重肿胀而入院。尽管囊袋部位培养[未提及具体病菌名称]呈阳性，但血培养呈阴性，且玫瑰红试验血清学滴度呈阳性。经食管超声心动图显示起搏器导线上有两个赘生物。患者接受强力霉素、利福平及庆大霉素治疗后完全康复，整个起搏器装置通过手术取出。有趣的是，在此次入院前两年，患者曾因脑膜脑炎就诊，诊断为神经型布鲁氏菌病，脑脊液培养[未提及具体病菌名称]生长阳性得以证实。患者接受强力霉素、利福平及庆大霉素治疗后完全康复，且当时已取出起搏器。在过去十年中，关于[未提及具体病菌名称]感染人工植入物和装置的报告有所增加。因此，在心脏装置感染的鉴别诊断和管理中应考虑疾病潜在复发及职业性接触[未提及具体病菌名称]的情况。
