PMC8141458_01
Erythema and swelling around CRT-P insertion site.
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Physical exam showed erythema, swelling, and tenderness to palpation at the left chest surrounding the pacemaker insertion site (Fig. 1).
TEE revealing vegetation at the anterior leaflet of the mitral valve.
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Transthoracic and transesophageal echocardiography demonstrated vegetation on the anterior leaflet of the mitral valve suggestive of endocarditis, but no vegetation on the device leads (Fig. 2, Fig. 3); nonetheless, the electrophysiology team performed a percutaneous CRT-P extraction on hospital day 7.
Respective MIC per Antimicrobial for E. cloacae.
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Treatment was narrowed to cefepime monotherapy targeting pacemaker and mitral valve endocarditis (Fig. 4).