CLINICAL SPOTLIGHT

Heart, Lung and Circulation (2014) 23, e222–e225 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.06.009

Pacemaker Endocarditis Caused by Propionibacterium acnes in an Adult Patient with Ebstein’s Anomaly: A Report of a Rare Case Karla R.E. Santo, MD a*, Vinicius Franceschi, MD a, Andre´ C.B. Campos, MD a, Thaı´ssa S. Monteiro, MD a, Giovanna I.F. Barbosa, MD b, Angela Dantas, MD c, Cristiane C. Lamas, MD, MRCP, PhD b,d,e a

Department of Myocardium, Pericardium and Aorta Diseases, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil Department of Infection Control, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil c Department of Microbiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil d Senior Lecturer, Unigranrio, Rio de Janeiro, Brazil e Infectious Diseases Inpatient Unit, Instituto de Pesquisa Clı´nica Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil b

Received 24 April 2014; received in revised form 9 June 2014; accepted 12 June 2014; online published-ahead-of-print 3 July 2014

We report a rare case of a Brazilian adult woman with Ebstein’s Anomaly who presented with pacemaker endocarditis caused by Propionibacterium acnes. Ebstein’s Anomaly is a rare congenital malformation of the heart. Infective endocarditis is defined as an infection of heart valves, of the mural endocardium, of a septal defect, or of a cardiac electronic implantable device. Propionibacterium acnes is a skin commensal bacterium, that is usually considered as a contaminant, but can, on rare occasions, cause serious infections including endocarditis of prosthetic valves, native valves and cardiac electronic implantable devices. Diagnosis was made after nearly two years of investigation by identification of the organism by the MALDI-TOF technique and transoesophageal echocardiogram. The patient was successfully treated with daptomycin and device removal. She remains free of endocarditis after 32 months of follow-up. Keywords

Infective endocarditis  Pacemaker  Ebstein’s Anomaly  Propionibacterium acnes  MALDI-TOF technique

Introduction Ebstein’s Anomaly is a rare congenital malformation of the heart that is characterised by an apical displacement of the attachment of the septal tricuspid valve leaflet from the right atrioventricular annulus, leading to atrialisation of the right ventricle [1,2]. The abnormal tricuspid leaflet morphology causes tricuspid regurgitation and right atrial enlargement. Symptoms can vary from exercise intolerance and palpitations to right-sided cardiac failure depending on the degree of tricuspid regurgitation [1]. Ebstein’s Anomaly accounts

for 150.000/mL), an erythrocyte sedimentation rate (ESR) of 71 mm (reference range

Pacemaker endocarditis caused by Propionibacterium acnes in an adult patient with Ebstein's anomaly: a report of a rare case.

We report a rare case of a Brazilian adult woman with Ebstein's Anomaly who presented with pacemaker endocarditis caused by Propionibacterium acnes. E...
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