Pacemaker Lead Endocarditis Caused By Aspergillus Fumigatus

Aspergillus is a ubiquitous mold that can cause a wide variety of clinical syndromes. Pacemaker lead infection due to Aspergillus is an uncommon complication of permanent pacemaker implantation. We report a case of an old man who presented with high grade fever of unknown origin with chills. He had history of pacemaker implantation 13 years ago with 2 pacemaker revisions. Transoesophageal echocardiography revealed multiple lead associated vegetations. Culture of vegetations on Sabouraud dextrose agar showed growth of Aspergillus fumigatus. The pacemaker was removed. The patient was administered liposomal Amphotericin B and voriconazole. Cardiac bypass surgery was done and the patient recovered fully. Although pacemaker lead endocarditis due to Aspergillus spp. is a rare complication of pacemaker implantation, a high index of clinical suspicion is required to timely diagnose the condition in individuals with implanted pacemaker who present with fever of unknown origin. Treatment includes aggressive surgical management including explantation of pacemaker lead along with vegetations and antimycotic therapy.