Background: Pacemaker endocarditis is a rare complication seen in patients with implanted pacemaker.
Case: We present a 70 year old female presenting with unremitting fever and chills for three months. She previously had pacemaker implantation for severe bradycardia. Transesophageal echocardiography showed large bilobed fluttering echogenic density attached to the pacemaker wire at the right atrial side prolapsing to the right ventricular inflow during diastole suggestive of vegetation. She underwent removal of right atrial and right ventricular lead; explantation of previously placed pulse generator; permanent pacemaker insertion (epicardial bed) and antibiotic therapy.
Conclusion: Pacemaker endocarditis should be suspected in patients who previously had pacemaker implantation and presenting with signs of endocarditis. Transesophageal echocardiography is the preferred imaging. Antibiotic therapy and surgical management are mainstays of treatment.