Invasive Listeriosis vegetation of pacemaker in 74-year-old.
This article describes the case of a 74-year-old patient with invasive listeriosis of intracardiac device. The patient’s medical history revealed permanent atrial fibrillation status-post nodal ablation, congestive cardiac failure and coronary artery disease. She presented to the emergency with complaints of generalised fatigue. However, she did not complain of any other symptoms including, dysuria, diarrhoea, abdominal pain, dyspnea and chest pain.
On examination the patient’s vitals, her blood pressure was 116/80, pulse 72 and respiratory rate 21. In addition, she was well saturated on 3 litres/minute nasal canal. Physical examination was consistent with pitting oedema in the lower extremities, jugular venous distension and bibasilar breath sounds. Laboratory investigations were unremarkable. However, the patient’s troponin levels were critically elevated. Chest X-ray was consistent with cardiomegaly, however, there were no signs of vascular congestion, effusions or consolidation. Doctors further advised urinalysis which showed no evidence of infection. The patient developed fever overnight with a temperature of 39.2°C.
Blood cultures were positive for gram positive rods.
Treatment included vancomycin. Doctors advised an echocardiogram over concerns of endocarditis which showed left ventricular ejection fraction 20 to 25%. There were signs of severe diffuse hypokinesis, moderate mitral and tricuspid regurgitation. In addition, there was a 1 mm mobile strand in the left atrium attached to pacer lead consistent with vegetation. The final blood cultures showed Listeria monocytogenes with two subsequent cultures growing listeria.
Doctors advised against surgical management and pacemaker removal because of comorbidities and advanced heart failure. Antibiotic vancomycin was continued. Ampicillin was not indicated because of high sodium content in the infusion setting of decreased systolic function. The patient was on IV vancomycin treatment for 6 weeks followed by amoxicillin oral suspension. The patient responded to treatment with resolution of fever and subjective improvement.
Invasive Listeriosis of Intracardiac Device https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932498/