Abstract
Infective endocarditis (IE) on stimulation lead is a rare but potentially serious complication, difficult to diagnose because clinical signs may be missing. The infection is most frequently located in the housing compartment; it can also reach the subcutaneous extravascular segment of the lead and its endovascular segment, particularly intracardiac. Blood cultures are sometimes negative because they have been decapitated by prior antibiotic therapy instituted during the implantation period. The curative treatment is in all cases, the extraction of the infected material, with bacteriological study of the latter for effective antibiotic therapy. We report the case of Mrs. DA, aged 30, obese, hypertensive, diabetic, followed for hypertrophic cardiomyopathy (HCM). She has had an implantable defibrillator (ICD) for a year, hospitalized for infective endocarditis on a lead. Before her hospitalization, the patient had presented a fever with infectious cellulitis, treated with antibiotic therapy for a month. She was referred to us for persistent fever. Transesophageal echocardiography (TEE) revealed a large vegetation on the lead, in its right intra-atrial segment. We will review this formidable complication, emphasizing diagnostic methods and therapeutic management.