Huge vegetation in a male with implantable cardioverter defibrillator

Due to the increasing use of cardiac implantable electronic devices, infective endocarditis associated with these devices has become more common in the recent years. Rapid diagnosis and appropriate treatment are key points to manage this infection successfully. However, the early diagnosis of cardiac devices implantation related endocarditis is not easy. There may be no obvious local infectious symptoms or signs initially. We describe an old man who was admitted due to pneumonia and final diagnosis was implantable cardioverter defibrillator (ICD) related infective endocarditis. Transthoracic cardioechography showed a huge vegetation (5.91 cm2) on the ICD tip in the right atrium, which was protruding into the right ventricle during diastolic phase. He was successfully treated with the surgery of removal of the infected device and proper antibiotics.