Persistent Septicemia after Complete Removal of an Infected Pacemaker System

Objective: This case report describes the clinical course of a 19-year-old patient suffering from repeated septicemia after complete removal of an infected transvenous pacemaker system. The initial symptom of repetitive septicemia persisted even after complete removal of the pacemaker system immediately when antibiotic therapy was discontinued. The patient already developed an antibiotic-induced renal insufficiency. In the total course, two university hospitals and a specialized pediatric cardiological center were involved. However, similar cases are likely to be observed anywhere else.

Methods: Different imaging procedures including PET-CT were performed without a seminal finding. Blood cultures changed over time from Staphylococcus to Proprioni species. No lead remnant or other focus was found.

Results: Complete removal of all massive calcified endovascular structures from the left subclavian vein and upper vena cava resolved the persistent septicemia. We found a clear coincidence between the septicemia and tube-like calcifications which remained after total lead extraction by a mechanical tool and consecutive open heart removal of the lead remnants. The elimination of any synthetic material alone which was completed in the first two procedures (transvascular lead extraction attempt and open heart lead remnant extraction through sternotomy) did not resolve the problem of a persistent septicemia until the extended calcifications were excised in a separate operation procedure (re-sternotomy and stepwise clamping of the anonymous vein and superior vena cava).

Conclusion: If septicemia persists after complete endovascular lead removal, there is a chance that bacteria remain at the site of fibrous tissue or calcifications requiring surgical intervention.

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