DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.048

Pages: 513-515

Cardiac implantable electronic device (CIED)- related infective endocarditis is one of the most severe complications following device implantation, and its incidence is increasing with the widespread use of the pacemakers and other cardiac devices. Diagnosis and management remain challenging, particularly regarding the optimal strategy for lead extraction. We report the case of a 72-year-old man with a pacemaker implanted in 2021 who presented fever for more than two months despite antibiotic therapy. The pacemaker pocket was clean and cardiac auscultation was normal. Transthoracic and transesophageal echocardiography revealed a large vegetation attached to the pacemaker leads without tricuspid valve involvement. Intravenous antibiotic therapy with vancomycin and gentamicin was initiated, later switched to teicoplanin due to persistent fever. Given persistent infection and large vegetation, surgical extraction was performed via sternotomy under cardiopulmonary bypass. The leads were removed with the vegetation and an epicardial pacemaker was implanted because the patient was pacing-dependent.