ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case
Introduction. Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections...
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Wiley
2021-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2021/9250967 |
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| author | Sardar Hassan Ijaz Ali Haider Jafry Areeba Shahnawaz Mark Allee |
| author_facet | Sardar Hassan Ijaz Ali Haider Jafry Areeba Shahnawaz Mark Allee |
| author_sort | Sardar Hassan Ijaz |
| collection | DOAJ |
| description | Introduction. Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections, and pocket-site infections, primarily involving Staphylococcus species. Infective endocarditis is a rare but life-threatening complication of gonococcal bacteremia. We report the first case of a CIED pocket-site infection secondary to Neisseria gonorrhoeae (N. gonorrhoeae). Case. A 56-year-old male with a history of congestive heart failure status postimplantable cardioverter-defibrillator (ICD) insertion presented with a pocket-site swelling initially concerning for a hematoma which began to exhibit erythema and tenderness. The patient reported a history of high-risk sexual behavior. On presentation, he was afebrile and hemodynamically stable. Physical exam showed a 5 cm × 6 cm pocket-site swelling with overlying erythema. Labs revealed elevated ESR and CRP levels. Transthoracic and transesophageal echocardiography was concerning for infective endocarditis and lead vegetations. Blood cultures tested positive for N. gonorrhoeae. He underwent surgical debridement with complete ICD extraction and drainage of infected serosanguineous pocket fluid. Tissue cultures were negative, but isolation of N. gonorrhoeae in blood cultures confirmed it as the causative agent of the pocket-site infection in the absence of prior Gram-positive coverage. He was started on a prolonged course of ceftriaxone for 4 weeks with reimplantation of ICD at a different site after completion of treatment. Conclusion. In patients with high-risk sexual behavior, gonococcal bacteremia can potentially lead to CIED infection. These individuals should be prudently evaluated for infective endocarditis or pocket-site infections as presenting complaints can be subtle. |
| format | Article |
| id | doaj-art-bc8bdf79d2e04f188b8763552f816691 |
| institution | Kabale University |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-bc8bdf79d2e04f188b8763552f8166912025-02-03T00:58:47ZengWileyCase Reports in Infectious Diseases2090-66252090-66332021-01-01202110.1155/2021/92509679250967ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported CaseSardar Hassan Ijaz0Ali Haider Jafry1Areeba Shahnawaz2Mark Allee3Department of Cardiovascular Disease, Lahey Medical Center, 41 Mall Road, Burlington, MA 01805, USA800 Stanton L. Young Blvd, AAT 6300, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, USAFaisalabad Medical University, Sargodha Road, Faisalabad, Punjab 38000, Pakistan800 Stanton L. Young Blvd, AAT 6300, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, USAIntroduction. Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections, and pocket-site infections, primarily involving Staphylococcus species. Infective endocarditis is a rare but life-threatening complication of gonococcal bacteremia. We report the first case of a CIED pocket-site infection secondary to Neisseria gonorrhoeae (N. gonorrhoeae). Case. A 56-year-old male with a history of congestive heart failure status postimplantable cardioverter-defibrillator (ICD) insertion presented with a pocket-site swelling initially concerning for a hematoma which began to exhibit erythema and tenderness. The patient reported a history of high-risk sexual behavior. On presentation, he was afebrile and hemodynamically stable. Physical exam showed a 5 cm × 6 cm pocket-site swelling with overlying erythema. Labs revealed elevated ESR and CRP levels. Transthoracic and transesophageal echocardiography was concerning for infective endocarditis and lead vegetations. Blood cultures tested positive for N. gonorrhoeae. He underwent surgical debridement with complete ICD extraction and drainage of infected serosanguineous pocket fluid. Tissue cultures were negative, but isolation of N. gonorrhoeae in blood cultures confirmed it as the causative agent of the pocket-site infection in the absence of prior Gram-positive coverage. He was started on a prolonged course of ceftriaxone for 4 weeks with reimplantation of ICD at a different site after completion of treatment. Conclusion. In patients with high-risk sexual behavior, gonococcal bacteremia can potentially lead to CIED infection. These individuals should be prudently evaluated for infective endocarditis or pocket-site infections as presenting complaints can be subtle.http://dx.doi.org/10.1155/2021/9250967 |
| spellingShingle | Sardar Hassan Ijaz Ali Haider Jafry Areeba Shahnawaz Mark Allee ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case Case Reports in Infectious Diseases |
| title | ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case |
| title_full | ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case |
| title_fullStr | ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case |
| title_full_unstemmed | ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case |
| title_short | ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case |
| title_sort | icd pocket site infection secondary to gonococcal bacteremia the first reported case |
| url | http://dx.doi.org/10.1155/2021/9250967 |
| work_keys_str_mv | AT sardarhassanijaz icdpocketsiteinfectionsecondarytogonococcalbacteremiathefirstreportedcase AT alihaiderjafry icdpocketsiteinfectionsecondarytogonococcalbacteremiathefirstreportedcase AT areebashahnawaz icdpocketsiteinfectionsecondarytogonococcalbacteremiathefirstreportedcase AT markallee icdpocketsiteinfectionsecondarytogonococcalbacteremiathefirstreportedcase |